Child's Details
Given Name (required)
Surname (required)
Date of Birth (required)
Gender (required) MaleFemale
Address (required)
Previous or current Kindergarten/Early Learning Centre attending
Please provide the Visa subclass number
Which level is this child starting at our Early Learning Centre? (required) 0-3 Years3-4 Years4-5 Years
Preferred Start Date
What days would your child attend (required) MondayTuesdayWednesdayThursdayFriday
Has your child had any outside agency support? (eg. WAYSS, Red Cross, DHHS, Child First NoYes
Please provide the Case Worker details
Has your child had any additional health support? (eg. Paediatrician, Speech, OT) NoYes
Please list the type of support
Parent Details Name (required) Phone number (required) Email Address (required)
Person completing this form (required) ParentLegal GuardianExternal Service
External Service Details Name of Service Contact Name Mobile number
Is an interpreter required? NoYes
Language spoken (required)
Please note: This is not an enrolment form. All other information including the enrolment form and transition dates will be sent at a later date.
