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Community Children's Centre

Autism Specific Early Learning and Care Centre - Margot Prior Wing

Waitlist application

To be placed on the Autism Specific Early Learning and Care Centre - Margot Prior Wing waitlist, please complete the form below and we will contact you as soon as possible.

Childs details

First and last name of child
Date of birth
Care required? Number of days and which days?
Diagnosis of Autism Spectrum Disorder?	Yes No Other
If other, please specify

Parent/Guardian details

Parent/carers full name
Address
Contact phone number
Email address
High priority status	Family Health Care card holder English as a second language Isolated family Parents or child has some additional needs Not applicable
Family Health Care card number (if applicable)
Association with the University	Staff Student Community
If a staff member: What area of University?
If a student: In what School?
If a member of the community: Do you live/work locally?