waiting list form

• Date

• Child's name in full
• Male Female

• parent 1's name in full
• parent 2's name in full

• address

• postcode
• phone Number
• w

• mobile number
• email
• child's Date of Birth

• Preferred year of enrolment
• cultural background

• language spoken
• other children

• preferred days
  (All 9am-3pm)

  Mon/Tues

  Wed

  Thurs/Fri

  Other

• Do ypu own a Health care/pension card?

• Is your child recongnised by their community as being of aboriginal or Torres Strait Islander Descent?

• Do you feel your child has an additional need that we should be aware of? eg: allergy, health, speech, physical or developmental problems ?
  Yes No
  Please share details

• How did you know we were here ?
  seen us

  other parent

  Phone book

  pamphlet/flyer

  other