St Kieran's Outside School Hours Care 63 Gordon Street, Manly Vale NSW 2093 T: 0481 602 078 E: W: Expression of interest Preferred days of attendance (please select) Date of application: Monday Tuesday Wednesday Thursday Friday Before school care school care Casual days only Child details 1 Child 2 3 Surname Given name(s) D.O.B. Gender Male Female Male Female Male Female School attending year Proposed start date Parent/Guardian 1 Parent/Guardian 2 Full name: Full name: DOB: DOB: Relationship to child: Relationship to child: Address: Address: T: M: W: T: M: W: Email: Email: Other relevant information Reason for care: Does your child have an additional need or require support? No Yes (Please provide details.)
St Kieran's Outside School Hours Care 63 Gordon Street, Manly Vale NSW 2093 T: 0481 602 078 E: W: Expression of interest Preferred days of attendance (please select) Date of application: Monday Tuesday Wednesday Thursday Friday Before school care school care Casual days only Child details 1 Child 2 3 Surname Given name(s) D.O.B. Gender Male Female Male Female Male Female School attending year Proposed start date Parent/Guardian 1 Parent/Guardian 2 Full name: Full name: DOB: DOB: Relationship to child: Relationship to child: Address: Address: T: M: W: T: M: W: Email: Email: Other relevant information Reason for care: Does your child have an additional need or require support? No Yes (Please provide details.)
St-Kierans_OSHC-Expression-of-Interest-Form.docx