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IHC - Register Interest

Parent/Guardian Details

First Name*
Please enter your first name.
Please enter your first name.
Last Name*
Please enter your last name.
Please enter your last name.

Date of Birth*

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
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  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Please enter your date of birth
Please enter your date of birth
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Please enter your date of birth
Please enter your date of birth
Year
Please enter your date of birth
Please enter your date of birth
Street Address*
Please enter your street address.
Please enter your street address.
Suburb*
Please enter your suburb.
Please enter your suburb.
Post Code*
Please enter your post code.
Please enter your post code.
State*
  • - select an option -
  • VIC
  • QLD
  • NSW
  • SA
  • TAS
  • WA
  • NT
  • ACT
Please select your state.
Please select your state.
Mobile Phone*
Please enter your mobile phone number.
Please enter your mobile phone number.
Home Phone
Field is required!
Field is required!
Work Phone
Field is required!
Field is required!
Email*
Please enter your email.
Please enter your email.
Combined Annual Family Taxable Income*
Please enter your annual income.
Please enter your annual income.
Child Care Subsidy Percentage*
Please enter your CCS%.
Please enter your CCS%.

Child Information

It is important to fill in all information for all your children.

Child 1

First Name*
Please enter your child's first name.
Please enter your child's first name.

Date of Birth*

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Please enter your child's date of birth
Please enter your child's date of birth
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Please enter your child's date of birth
Please enter your child's date of birth
Year
Please enter your child's date of birth
Please enter your child's date of birth

Child 2

First Name
Please enter your child's first name.
Please enter your child's first name.

Date of Birth

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Field is required!
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Field is required!
Field is required!
Year
Field is required!
Field is required!

Child 3

First Name
Please enter your child's first name.
Please enter your child's first name.

Date of Birth

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Field is required!
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Field is required!
Field is required!
Year
Field is required!
Field is required!

Child 4

First Name
Please enter your child's first name.
Please enter your child's first name.

Date of Birth

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Field is required!
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Field is required!
Field is required!
Year
Field is required!
Field is required!

Child 5

First Name
Please enter your child's first name.
Please enter your child's first name.

Date of Birth

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Field is required!
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Field is required!
Field is required!
Year
Field is required!
Field is required!

Child 6

First Name
Please enter your child's first name.
Please enter your child's first name.

Date of Birth

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Field is required!
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Field is required!
Field is required!
Year
Field is required!
Field is required!

Child 7

First Name
Please enter your child's first name.
Please enter your child's first name.

Date of Birth

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Field is required!
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Field is required!
Field is required!
Year
Field is required!
Field is required!

Position Description

Required Hours*

So that we can give you the most accurate cost estimate possible, we need a snap shot, a sample scenario of the most typical or common example of the hours that you would require a nanny to work on a regular weekly basis. Fill in the times based on the longest hours you would require on any given day. Include the time it takes to travel to and from work / study / training.

Monday

Shift 1 Start Time
Field is required!
Field is required!
Shift 1 Finish Time
Field is required!
Field is required!
Shift 2 Start Time
Field is required!
Field is required!
Shift 2 Finish Time
Field is required!
Field is required!

Tuesday

Shift 1 Start Time
Field is required!
Field is required!
Shift 1 Finish Time
Field is required!
Field is required!
Shift 2 Start Time
Field is required!
Field is required!
Shift 2 Finish Time
Field is required!
Field is required!

Wednesday

Shift 1 Start Time
Field is required!
Field is required!
Shift 1 Finish Time
Field is required!
Field is required!
Shift 2 Start Time
Field is required!
Field is required!
Shift 2 Finish Time
Field is required!
Field is required!

Thursday

Shift 1 Start Time
Field is required!
Field is required!
Shift 1 Finish Time
Field is required!
Field is required!
Shift 2 Start Time
Field is required!
Field is required!
Shift 2 Finish Time
Field is required!
Field is required!

Friday

Shift 1 Start Time
Field is required!
Field is required!
Shift 1 Finish Time
Field is required!
Field is required!
Shift 2 Start Time
Field is required!
Field is required!
Shift 2 Finish Time
Field is required!
Field is required!

Saturday

Shift 1 Start Time
Field is required!
Field is required!
Shift 1 Finish Time
Field is required!
Field is required!
Shift 2 Start Time
Field is required!
Field is required!
Shift 2 Finish Time
Field is required!
Field is required!

Sunday

Shift 1 Start Time
Field is required!
Field is required!
Shift 1 Finish Time
Field is required!
Field is required!
Shift 2 Start Time
Field is required!
Field is required!
Shift 2 Finish Time
Field is required!
Field is required!
Will this be the same time each week on a regular basis?*
Please answer the question.
Please answer the question.
Are you flexible with the days and times required?*
Please answer the question.
Please answer the question.

When would you like the care to commence?*

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Please enter your commencement date
Please enter your commencement date
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Please enter your commencement date
Please enter your commencement date
Year
Please enter your commencement date
Please enter your commencement date
Is this position ongoing?*
Please answer the question.
Please answer the question.

If No, possible finish date?

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Field is required!
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
Field is required!
Field is required!
Year
Field is required!
Field is required!
Do you plan to bring your own educator?*
Please answer the question.
Please answer the question.

In Home Care

Have you spoken to the In Home Care Support Agency?* (note - if you haven't yet, we can introduce you later in the process)
Please answer the question.
Please answer the question.
Who is your Family Liaison Officer at the Support Agency?
Please enter your family liaison officer.
Please enter your family liaison officer.
Has the Support Agency created (or is in the process of creating) your Family Management Plan?
Please answer the question.
Please answer the question.

Confirmation

I confirm that all information completed within my Registration form is true and accurate. I also agree to allow ALHCA to share my information with Educators, the In Home Care Support Agency, the Department of Education, the Department of Human Services, Child Care Subsidy Help Desk and Software Providers, fellow Service Providers, ACCS referral organisations and other authorised personnel.*
Please confirm.
Please confirm.

If you haven’t already contacted the In Home Care Support Agency and would like to start the process, please go to https://ihc.org.au/apply-mlna/ to fill out the form and one of their Family Liaison Officers will contact you to assess your eligibility for the program.

If you haven’t already contacted the In Home Care Support Agency and would like to start the process, please go to https://ihcsupportagency.org.au/make-a-referral-now/ to fill out the form and one of their Family Liaison Officers will contact you to assess your eligibility for the program.

If you haven’t already contacted the In Home Care Support Agency and would like to start the process, please go to https://www.wanslea.org.au/families-and-children/in-home-care-support-agency/families#contact to contact them and one of their Family Liaison Officers will contact you to assess your eligibility for the program.

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