"*" indicates required fields X/TwitterThis field is for validation purposes and should be left unchanged. Childcare Abuse Class Action Form First Name*Last Name*Postcode*Suburb*First ChoiceSecond ChoiceThird ChoiceEmail* Phone*Childcare centre(s) child attended:*Child's age at time of attendance:Dates child attended centre:Did you receive a notification to have your child tested for STIs? Yes No Was your child an attendee of an impacted daycare centre, or assaulted by the offender? Attendee Only Assaulted Attendee, but unsure if assaulted Your relationship to the child: Parent Guardian Family member Other CAPTCHAYou can also send a completed copy of this form to [email protected]