Register Interest

Child's Details
Child's Full Name*
Date of Birth*
Date Format: DD slash MM slash YYYY
Gender*
- Male
- Female
What day/days does your child require care?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- We're Flexible
Anticipated Commencement Date*
Date Format: DD dash MM dash YYYY
CRN*
Would you like to add another child*
- Yes
- No
Additional Child's Details
Child's Full Name
Date of Birth
Date Format: DD slash MM slash YYYY
Gender
- Male
- Female
What day/days does your child require care?
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- We're Flexible
Anticipated Commencement Date
Date Format: DD dash MM dash YYYY
CRN
Other Details
Reason for care?*
Reason
Arrange a time for a Tour of our facilities*
Please choose 2 days that will suit you for a tour*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Please select a time that would suit
Parent/Guardian Name*
Date of Birth*
Date Format: DD slash MM slash YYYY
CRN
Phone Number*
Email*
How did you hear about our Centre?*
- Yellow Pages
- Kidz Retreat website
- Previous client
- Drove past
- Flyer
- Brochure
- Local directory
- Current client
- Internet site
- Centre sign
- Markets
- Other
Please Specify
Please include some further details about how you found us as it helps us with our marketing efforts.

Child's Details