Port Fairy Community Services Centre Application Form Please note: use ONE form per child, use BLOCK LETTERS last name: ________________________ Child’s first name: _____________________ Child’s date of birth: ___________________ Child’s Parent /guardian 1 Parent /guardian 2 Please note: this parent will be the main contact Name:__________________________________ Name:__________________________________ P/code: P/code: T home: T home: T business: T business: Mob: Mob: Email: Email: Long Day Care Please tick () Full Day: 7:30 am 6:00 pm – $96.00 Per day Monday Tuesday Wednesday Thursday Friday Please turn over
Port Fairy Community Services Centre Application Form Please note: use ONE form per child, use BLOCK LETTERS Child’s first name: _____________________ Child’s last name: ________________________ Child’s date of birth: ___________________ Parent /guardian 1 Please note: this parent will be the main contact Parent /guardian 2 Name:__________________________________ P/code: T home: T business: Mob: Email: Name:__________________________________ P/code: T home: T business: Mob: Email: Long Day Care Please tick () Full Day: 7:30 am – 6:00 pm $96.00 Per day Monday Tuesday Wednesday Thursday Friday Please turn over
pfcsc-ldc-application-form-2017.docx