Waiting List Application

Child's Information

Child's First name

Child's Last name

Date of Birth

Years / Months

Gender

Male

Female

When would you like to commence?

__________________________________________________________________

Parent/Guardian One

Parent/Guardian 1 - First Name

Last Name

Address

Phone contacts

Mobile Phone

Work Phone

Home Phone

Email

Occupation

Languages spoken

In order to comply with the Department of Education, Employment and Workplace Relations guidelines and to ensure priority of enrolment on a needs basis, the following information is required. *Please select those applicable

__________________________________________________________________

Parent/Guardian Two

Parent/Guardian 2 - First Name

Last Name

Address

Phone contacts

Mobile Phone

Work Phone

Home Phone

Email

Occupation

Languages spoken

In order to comply with the Department of Education, Employment and Workplace Relations guidelines and to ensure priority of enrolment on a needs basis, the following information is required. *Please select those applicable

__________________________________________________________________

Do you or your child have any health problems or disabilities?

Yes

No

Details:

Are you at home with several children?

Yes

No

Details:

Are there any special circumstances?

Yes

No

Details:

Name of referral:

DECLARATION

This is NOT an ENROLMENT FORM and there is NO GUARANTEE of a PLACEMENT*

I, Parent/Guardian One, agree that by completing this form my child’s name will go on your waiting list. I understand that there is no guarantee of placement

I, Parent/Guardian Two, agree that by completing this form my child’s name will go on your waiting list. I understand that there is no guarantee of placement