Skip to main content

Alternate Location Permission Request

This form is to apply for 1 OR MORE sessions of care to be provided at an alternate location. For example, Mini School, School Camp, Renovations, an Emergency, Work-related reasons, etc.

PLEASE ONLY INCLUDE 2 ALTERNATE LOCATION REQUESTS IN THIS FORM. IF YOU NEED TO COMPLETE ANOTHER FORM, PLEASE SUBMIT AND THEN COMPLETE A NEW FORM.

Client Details

First Name*
Please enter first name.
Please enter first name.
Last Name*
Please enter last name.
Please enter last name.
Email*
Please enter email.
Please enter email.

Educator Details

First Name*
Please enter first name.
Please enter first name.
Last Name*
Please enter last name.
Please enter last name.
Email*
Please enter email.
Please enter email.

Usual Address

Street Address*
Field is required!
Field is required!
Suburb*
Field is required!
Field is required!
Postcode*
Field is required!
Field is required!
State*
  • - select a option -
  • VIC
  • QLD
  • NSW
  • SA
  • TAS
  • WA
  • NT
  • ACT
Field is required!
Field is required!

Alternate Address Information

Add all children related to this alternate location permission request

Childs First Name*
Field is required!
Field is required!
Childs Last Name*
Field is required!
Field is required!

Add child

Alternate Street Address*
Field is required!
Field is required!
Suburb*
Field is required!
Field is required!
Postcode*
Field is required!
Field is required!
State*
  • - select a option -
  • VIC
  • QLD
  • NSW
  • SA
  • TAS
  • WA
  • NT
  • ACT
Field is required!
Field is required!
Coordinates of alternate address (if required)
Field is required!
Field is required!
Accommodation Type*
  • - select a option -
  • AirBNB
  • Hotel
  • Apartment
  • House
  • Cabin
  • Caravan
  • Park
  • Tent
  • Other
Field is required!
Field is required!
Please describe accommodation type*
Field is required!
Field is required!
Purpose of temporary change of address*
  • - select a option -
  • Mini School
  • School Camp
  • Other
Field is required!
Field is required!
Name of school*
Field is required!
Field is required!
Please describe the reason for a temporary change of address*
Field is required!
Field is required!
Start date*
Field is required!
Field is required!
End date*
Field is required!
Field is required!

Add in extra dates for the same address

Local Contact Details for Medical, Police, Fire and Emergency Services

Medical Services

Name of local medical services*
Field is required!
Field is required!
Address for local medical services*
Field is required!
Field is required!
Contact number for medical services*
Field is required!
Field is required!

Police Services

Address for local police services*
Field is required!
Field is required!
Contact number for local police services*
Field is required!
Field is required!

Fire and Emergency Services

Address for local fire and emergency services*
Field is required!
Field is required!
Contact number for local fire and emergency services*
Field is required!
Field is required!

Add another request for an alternate location

Confirmation

I agree to provide ALHCA with the opportunity to undertake a Home Safety update with the educator prior to the first session, of each block of care, at the alternate address
Field is required!
Field is required!
I agree to provide the Educator with the opportunity to complete a hazard assessment and management form prior to the first session, of each block of care, at the alternate address
Field is required!
Field is required!
I agree to provide the Educator with the opportunity to complete an event specific excursion plan prior to the first session, of each block of care, at the alternate address
Field is required!
Field is required!
I agree to provide the Educator with safe accommodation during the stay
Field is required!
Field is required!
I may need to change the start and finish times of sessions (and understand that session times may differ between children), as to not overlap face to face distance education sessions with the children’s teacher:
Field is required!
Field is required!