Get documents about "Application for variation of children's service approval: CSVAR 1
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CSVAR 1
Application for variation of children’s service approval
This form is to be completed by a licensee of an approved children’s service applying for a variation to their
children’s service approval. Please print with a black or blue pen. For information or assistance with this
form, phone 02 9716 2100 or 1800 619 113. Please mark relevant boxes with a X. If you need more room
to answer any questions, please include details on a separate page and attach it to this form.
Note: Community Services will use the information you are asked to provide on this form for the purposes
of assessing this application. All personal details provided, except for those which must be displayed on a
licence or in the Children’s Services Register, will be kept confidential to Community Services.
This form should be used to inform Community Services:
Of a change in name of an approved children’s service, or
Of a change of address for the coordinating office of a mobile or family day care children’s service,
or
To vary the maximum number of children that may attend a service, or
To add or remove a mobile venue from a mobile children’s service.
Details of approved children’s service
Children’s service
approval number*
Name of service (as
shown on approval)
Street address
Suburb/town Postcode
Details of licensee
Service provider
licence number
Licensee name (as
shown on licence)
Person for Community Services to contact about this application
Name
Position
Daytime phone Mobile
*
If the service was licensed before 1/1/2011 this number will be the children’s service ‘licence number’.
Leave blank if you were the licensee of a service on 31/12/2010 but to do not yet have a provider licence number.
Application for variation of children’s service approval Page 1 of 3
Fax
Email
Details of variation
Please tick the proposed variation(s) from the list below and provide any relevant documents.
Variation Current information New information Documents required
Change in Maximum total number at Maximum total number at If the premises need
maximum any one time: any one time: alteration, renovation etc
number of to accommodate the new
children number, you must give
Community Services
advance notice on
CSNCP 1 - Notice of
proposed changes to
premises. You must also
provide a completed
Statement of premises
compliance (CSCS 1) or
Statement of premises
non-compliance (CSCS
2).
Change in Current name: New name: Documents not required
name of service
(ownership of
service not
changing)
Change of Current address: New address: Documents not required
address of
coordinating
office of mobile
or family day
care service
Add a mobile Address: Completed CSV1 01
venue Venue Information for
Mobile Children’s
Service, CSCS 3
Statement of Venue Non-
compliance, and Venue
Management Plan (only
if applicable)
Remove a Address: Documents not required
mobile venue
Application for variation of children’s service approval Page 2 of 3
Declaration by licensee
Under section 253 of the Children and Young Persons (Care and Protection) Act 1998, it is an
offence in an application under the Act or Regulations to make a statement or furnish information
that a person knows to be false or misleading.
Please read and sign the declaration below:
I understand the instructions on this form.
To the best of my knowledge, the information provided on this form, including any attachments, is
true and correct.
All development consents or modified development consents (if any) required under the
Environmental Planning and Assessment Act 1979 in connection with the requested change/s have
been obtained.
Where I am making this declaration as the applicant’s delegate, I am duly authorised to do so.
Name of
licensee/delegate
Signature of
licensee/delegate
Date
Please send your completed form and all associated documents to:
Director, Central Licensing and Regulatory Support
Children’s Services Directorate, Community Services
Locked Bag 4028
Ashfield NSW 2131
For enquiries, phone 02 9716 2100 or 1800 619 113 or email cslicensing@dhs.nsw.gov.au
Only a licensee which is an organisation can sign by a delegate.
Application for variation of children’s service approval Page 3 of 3
