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

MaleFemale
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

YesNo
If answered yes to above, please provide details
Please provide details of anything you think your child may required extra suport with eg. Diet, Sleep, Behaviour, Play, Toileting, Language
During your child's kindergarten year will your child also attend another early childhood program?

YesNo
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.

YesNo
How did you hear about us?

Friend / Word of mouthGoogleFacebookOther
If your contact details change, please contact the centre to update our files.
Should be Empty: