Early Learning Expression of Interest

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

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

Has your child had any additional health support? (eg. Paediatrician, Speech, OT)
NoYes

Parent Details
Name (required)

Phone number (required)

Email Address (required)

Person completing this form (required)
ParentLegal GuardianExternal Service

Is an interpreter required?
NoYes

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.