Maternal Child Health Booking/ Enquiry Request

Your Child's Details

Child's First Name *

Child's Last Name *

Date of Birth *

Key Age *If the appointment required is outside Key Age and Stage appointments above, please contact Maternal and Child Health administration between 9:00am and 5:00pm, Monday to Friday on 03 5559-4470.

Appointment Details

Other Details

Your Details

First Name *

Last name *

Relationship to Child *

MotherFatherGuardian

Contact Number *

email address *

Other Comments

Declaration

I have read and agree with the Warrnambool City Council Privacy Policy *

Read the Warrnambool City Council privacy Policy here

The information collected on this form is required by Warrnambool City Council. If this information is not collected the application cannot be processed. The applicant may apply to Council for access and/or amendment of the information by contacting Council’s Freedom of Information/Privacy officer on 03 5559 4800 or privacy@warrnambool.vic.gov.au