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

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

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