REGISTRATION FORM
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
*
I would like my child to attend from the beginning of the term in which they have their second birthday
I would like my child to attend immediately following their second birthday
Or, I would like my child to attend from the following dates (add dates below)
Date
-
Day
-
Month
Year
Date
Name of Parent
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Back
Next
Preferred group (if applicable)
Preferred Days (minimum 3)
Monday
Tuesday
Wednesday
Thursday
Friday
If your child has a URN from Achieving for Children for 2-year funding, please enter it below:
Any Other Notes:
Date
*
-
Day
-
Month
Year
Date
Signature
*
Submit
Should be Empty: