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Enquiry Form
YOUR DETAILS
Name
*
First Name
Last Name
Email
*
Mobile No
*
Address
*
Relationship to child
*
Mother
Father
Brother
Sister
Grandmother
Grandfather
Aunt
Uncle
Cousin
Family Friend
Primary Guardian
Secondary Guardian
Place of Work
Whanau
Caregiver
Godfather
Godmother
Nanny
Other
Stepfather
Stepmother
How did you hear about us?
CHILD DETAILS
Name
*
First Name
Last Name
Gender
*
Male
Female
Other
Unknown
Date of birth
*
MM
DD
YYYY
Desired start date
*
MM
DD
YYYY
How many days childcare do you need?
*
1
2
3
4
5
Days required
*
Monday
Tuesday
Wednesday
Thursday
Friday
Has your child been in childcare before?
*
Yes
No
Is your child toilet trained?
*
Yes
No
Comments (optional)
Thank you!
For additional children please submit a new form. Thanks