Date of Birth*
Place of Birth
Language spoken at home
Are you taking any prescribed medication?
Previous / Current Occupation
Do you have any Learning Needs?
Do you have a First Aid Certificate? yesno
Do you have a Working with Children Blue Card? yesno
CPR Certificate? yesno
Childcare experience (including another Family Day Care Scheme)
Do you have any knowledge of Family Day Care?
Do you or any family members that reside at the home have any previous or current Blue Card, Domestic violence, Court orders or child safety issues that we need to know?
Partner's Name / Emergency Contact*
Place of work
Date of Birth*
All adult occupants of the home, over the age of 18years, are required to obtain a Working with Children Blue Card.
Home owner yesno
Style of Home
Low setHigh setUnitTown House
Do you have written permission from landlord? yesno
Is there a separate area the pet/s can go when children are involved in outside play? (regulation requirement) yesno
Fully Fenced Yard yesno
Swimming pool (with locked gate) and suitable fencing yesno
Does anyone in the home smoke? If yes, explain strategies to implement for Family Day Care
Do you have the use of a motor vehicle? yesno
How many seat belts?
Do you agree to obtain a vehicle safety check every 12 months? yesno
Do you have suitable spaces inside and outside your home for the children to play safely? Please explain
Where would the children rest/sleep?
Do you have shaded area outside for the children to play? Explain
Details of Care Preferences:-
Full Time yesno
Part Time yesno
Overnight or Weekend yesno
Work hours between am and pm
1-2 years: yesno
School Age: yesno
Special Needs Children: yesno
Children from Different cultures: yesno
Do you agree to have your home address & phone and mobile number displayed on Educator List to other Educators in the Setting ( to only be used for Family Day Care purposes) yesno
Do you agree to receive all correspondence by supplied email address and advise any changes to above address? yesno
Why are you interested in becoming a Family Day Care Educator? yesno
How did you hear about Hatchling House Family Day Care?