Cybertots child care

Abdul Anya

Enrolment Form

Parent/Guardian Details

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Immunisation Record

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Ben Adam

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Bernard Kerere

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Bronte Healy

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Concetta Maria Perroni

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Curtis Michael Fox

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Eliza Matthews

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Ella Biltson

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Emily Snowden

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Harry Christopher Franks

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Jaella Jane Smith

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Jarrad Aphoo Buddrooman

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Juanita Lopez

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Louise Emma Taylor

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Matu Yazdani

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Owen Forbes

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Rawinia Joy Fox

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Samuel Lawrence

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Simon Charles Biltson

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Thomas Benjamin Lantra

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Zeyneba Shariaty

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Family Day Care

Ivan Markovski

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Jessica McDonald

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Simon Brown

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Tyler Maine

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Immunisation Record

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Emergency Contact Information

Enrolment form

Surname (enrolling parent/guardian): Lopez Surname (child): Lopez Given name/s of child: Juanita Ann

Orientation visit dates

1. 00/00/2000 Comments: 2. 00/00/2000 Comments: 3. 00/00/2000 Comments: Date to commence: 28/01/2008

Child’s details

Surname: Lopez Given name/s: Juanita Lopez Gender: Female DOB: 23rd September 2002 Birth extract presented? Yes Address: Unit 2/364 Breaker Drive Joondalup 6027 Telephone: 9555 2121 Reason for care:
(to confirm priority of access): Both parents working

Parent(s)/Guardian(s) details

Parent/Guardian 1

Surname: Lopez Given name/s: Rosa Address: Unit 2/364 Breaker Drive Joondalup Post Code: 6027 Home telephone: 9555 2121 Work telephone: 9233 1210 Alternate contacts? Nil Place of work or study: Snuggles Child Care Centre Address of work/study: 1 Mount Lawley Drive, Maylands 6050 Days/hours of work or study: (shift work) 7-3.30/8-4.30/9.30-6pm Mon to Fri

Parent/Guardian 2

Surname: Lopez Given name/s: Petro Address: Unit 2/364 Breaker Drive Joondalup Post Code: 6027 Home telephone: 9555 2121 Work telephone: 9233 1128 Alternate contacts? Nil Place of work or study: Max’s Chickens Address of work/study: Lot 27 Magnum Rd, Neerabup 6029 Days/hours of work or study: 6.00am to 3.00pm Mon-Sat (sometimes overtime)