Beechworth Community Childcare Centre :: Request for Care

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Request for Care

To organise childcare at Beechworth Community Child Care Centre you must fill in the 'Request for Care' form. Follow the steps below.

  1. Contact the Family Assistance Office/Centrelink and receive a Customer Reference Number for the parent/family AND a Customer Reference Number for each child. Telephone: 13 61 50 and quote Beechworth Community Child Care Centre Organisation ID 1-3C8-28

  2. Fill in the Request for Care form below and press the submit button or fill in the Request for Care form PDF File attached and return it to the centre. Make sure you include a start date. The centre will contact you to discuss start dates, room availability or going on to the waiting list.

  3. Read the Centre Information Booklet. It will give you most of the information you require.

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Request for care form

Please Note: This is not an enrolment form it is an application for care.

Parent/Guardian 1
Registered Parent Family Name * First Name *
Date of Birth

Centrelink Customer Reference Number (CRN) *

Parent/Guardian 2
Family Name First Name
Date of Birth

Home Address
Town Postcode

Telephone (AH) * (BH)
Mobile Email *

Care required from
Start Date * End Date

Child's Family Name Child's Given Name Date of Birth CRNumber Room Required
1.
2.
3.

Please tick below the days care is required
  Monday Tuesday Wednesday Thursday Friday
Full Day

  • The Department of Family and Community Services and Indigenous Affairs determine Priority of Access rules.
  • A registration fee of $100.00 will be required to secure your child’s position at Beechworth Community Child Care Centre. This amount will be deducted from your final weeks of care or rolled over to the following years care

Study, Training and Employment Details - please supply details

Study or Training Details Parent/Guardian 1
Relationship to child Place of Study/Training
Contact Telephone Student Number Duration
Study or Training Details Parent/Guardian 2
Relationship to child Place of Study/Training
Contact Telephone Student Number Duration

Employment Details Parent/Guardian 1
Relationship to child Place of Employment
Address Contact Telephone
Employment Details Parent/Guardian 2
Relationship to child Place of Employment
Address Contact Telephone

Non-working Details Parent/Gurdian 1
Relationship to child
Address Contact Telephone
Non-working Details Parent/Gurdian 2
Relationship to child
Address Contact Telephone

Other Information - please tick all relevant boxes if the answer is yes
Aboriginal and/or Torres Strait Islander descent
An immediate member of the family has a disability
Single Parent Family
Allergy or additional need (for planning a smooth transition)


We hope this information will ensure a smooth transition for yourself and your child/ren.

If we can assist with further information, please do not hesitate to contact the centre on (03) 57282378 or by email contact@beechworthchildcare.com.au