Quality and affordable care for your child in leafy East Melbourne.

Join the Waiting List

  1.  

    Child's Details

     
  2. Child's First name:*
     
  3. Child's Sex:*
     
  4. Child's Date of Birth (Or Expected):*
     
  5. Care Requested:*
     
  6. Date you want care to start from (ideally):*
     
  7. Does the child has sibling at EMCC?*
     
  8. Address:*
     
  9. Suburb:*
     
  10. Postcode:*
     
  11. Home Phone:*
     
  12.  

    Your Details

     
  13. Your Surname:*
     
  14. Your First Name:*
     
  15. Mobile Number:*
     
  16. Work Number:*
     
  17. Work Email Address: *Please do NOT use free email accounts(e.g. yahoo, hotmail, gmail)
    (A valid work email or email provided by your ISP is required)
  18. Where do you work? *
     
  19. Preferred Language:*
     
  20. Aboriginal or Torres Strait Islander:*
     
  21. Do you have a partner?*
    Yes
     
  22.  

    Partners Details

     
  23.  

    If you do not have a partner, please leave this section BLANK

     
  24. Partner's Surname:
     
  25. Partner's First Name:
     
  26. Mobile Number:
     
  27. Work Number:
     
  28. Email Address:
    (If no email address, please leave BLANK)
  29. Where does your partner work?
     
  30. Language:
     
  31. Aboriginal or Torres Strait Islander:
     
  32.