Childcare Enquiry Form

Name:*
First Last
Address*
Street Address City ZIP / Postal Code
Best Contact Number*
Alternate Contact Number
Your Email Address:*
Your Childrens Details*
Childs Name DOB Gender
In what district do you want the care to take place?*
- Napier
- Hastings
- CHB
Have you chosen an Educarer already?*
- Yes
- No
If "Yes" then who have you chosen?
What are the hours of care you may be needing?
Childs Name Monday Tuesday Wednesday Thursday Friday
Will you be applying for a WINZ Subsidy?*
- Yes
- No
- Unsure
If "yes" how many Hours will you be applying for?
Please enter a number less than or equal to 50.
Will using any of your 20 ECE hours (for 3 to 5 yr olds) with Bright Futures?
- Yes
- No
- Unsure
If "yes" how many hours
Please enter a number less than or equal to 20.
Additional Comments
And Finally, how did you hear about us?*
- Radio
- Newspaper
- Facebook
- Website
- Friend
- Educarer
- Other
CAPTCHA

“Bright Futures childcare and learning is a service of Napier Family Centre, an award winning not for profit social service agency. Any surpluses we make go right back in, to help provide a better service to our local communities.”

Childs Name	DOB	Gender

Childs Name	Monday	Tuesday	Wednesday	Thursday	Friday