Child's First Name*

Child's Surname Name*

Sex*
MaleFemale

Date Of Birth* (format e.g. 01-Jan-2015)

Child's Address*

Suburb*

Postcode*

Country of Birth*

Languages spoken*

Is your child from Aboriginal or Torres Strait decent?*
NoYes

Parent/Guardian' s Name*

Phone

Mobile*

Email Address*

In order to comply with guidelines determined by the Child Care Section, Department of Community Services, Preschools funding body, and to ensure priority of enrolment on a needs basis, you are requested to supply the following information:

Two Parent Family
N/ABoth parents working full-timeOne parent working full-time, one part-timeOne parent full-time, one not workingOne parent part-time, one not workingBoth parents part-timeBoth parents not working

Sole Parent Family
N/ASole parent working full-timeSole parent working part-timeSole parent not working

As we provide some support for children with additional needs, please state any additional needs your child may have; including allergies, developmental delays, Non-English speaking background etc

Are there any concerns relating to your child's developmental milestones?

Please list any support services your child is attending i.e. speech therapy, OT etc

Does your family hold a Low Income Health Care Card as your family may be eligible for a subsidy*
NoYes

How did you hear about us?*
Word of MouthDrive PastWebsiteOther

If Other, please indicate how:

By filling out this form your child’s name goes on to a waiting list. We recommend that you place your child/ren on waiting lists at other centres to provide you with a choice as there is no guarantee that you will be offered a place at or preschool.

Year to attend
(Note: Generally children need to be turning 4 by 31st July in the year of attendance. Children turning 4 after 31st July attend the following year)

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