Child’s Name:	Click here to enter text.
Date Of Birth:	Click here to enter a date.	Gender:	Choose an item.
Address:	Click here to enter text.
Tel Home:	Click here to enter text.	Mobile:	Click here to enter text.
Tel Work:	Click here to enter text.	Email:	Click here to enter text.
Place In Family:	Click here to enter text.

Please indicate below the preferences you have for when you will need a place and how many days you would require. (This information is for filing purposes, as spaces are reliant on availability.)

Start date:	Click here to enter a date.	Number of days required:	Choose an item.
Preferred days of the week:	Click here to enter text.	Finish date:	Click here to enter a date.

How did you hear about us? Choose an item.

Feel free to contact us and get updates on the waiting list.

Signature:

Name:	Click here to enter text.

Date:	Click here to enter a date.

Email: waitinglist@christopherrobin.co.nz Post: 4 Sherwood Ave, Grey Lynn. 1021