Memorial Park Community Kindergarten Pre Enrolment / Wait List Form

Memorial Park Community Kindergarten Pre Enrolment / Wait List Form
Child's First Name/s
Child's Surname
Child's Date of Birth

DayMonthYear
Date
Please email a copy of your child's birth certficate to:

mail@memorialparkkindy.com.au
Child's Gender
Child Address
Enter your child's eligible Kindy year (must turn 4 by 30 June in year they attend)
Parent/ Guardian 1 Name
Parent/ Guardian 1 DOB

DayMonthYear
Date
Parent/ Guardian 1 Address
Parent/ Guardian 1 Mobile Phone #
Parent/Guardian 1 Email address
Parent/ Guardian 2 Name
Parent/ Guardian 2 DOB

DayMonthYear
Date
Parent/ Guardian 2 Address
Parent/ Guardian 2 Mobile Phone #
Parent/ Guardian 2 Email Address
Does your child have any additional needs or are seeing any specialists? eg OT's, Speech Pathologists
If answered yes to above, please provide details
Does your child have a medical condition?
If answered Yes to the above question, please list the medical condition
Does your child have Asthma
Does your child have Anaphylaxis?
If your child has been diagnosed with anaphylaxis, please specify the known trigger(s) below
Does your child have an Allergy?
If your child has been diagnosed with an allergy, please specify the known trigger(s) below
Please provide details of anything you think your child may required extra support with eg. Diet, Sleep, Behaviour, Play, Toileting, Language
During your child's kindergarten year will your child also attend another early childhood program?
If your child gains a placement in our kindergarten program, do you acknowledge this as your only access to the 15 hours of an Approved Kindergarten Program? Priority is given to families who acknowledge this service as their provider due to government funding eligibility.
Any further information?
How did you hear about us?
If your contact details change, please contact the centre to update our files.
Should be Empty: