Connect Preschool Waitlist Form

131 Woronora Road

Engadine 2233

Phone: 9520 6959

Email: office@connectpreschool.com

WAITLIST FORM

CONNECT PRESCHOOL
Name

Child's SurnameChild’s First Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
M/F
Address
Postcode
Parent Phone 1:
Format: (00) 0000-0000.
Parent Phone 2:
Format: (00) 0000-0000.
Email (please print clearly)
example@example.com
PLEASE NOTE: ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL
1. Is your child Aboriginal or Torres Strait Islander?
2. Country of birth for child
for parent/Guardian 1
for parent/Guardian 2
3. What is the MAIN language spoken at home?
4. Any other languages spoken at home?
5. Does your child have an ongoing health or medical condition? (eg. Asthma, Anaphylaxis)
6. Does your child have a developmental delay or disability? (eg. Speech, Physical, Social Skills)
7. Does your child have any challenging behaviours that concern you?
8. Do you have a Health Care card or Pensioner card? If No, please write no. If Yes, please fill in the card no:
9. Where did you hear about us?
PLEASE DISCUSS OPTIONS WITH STAFF BEFORE COMPLETING THIS SECTION
1. What year/s do you wish your child to attend Pre-School?
Preferred days
2. What year/s do you wish your child to attend Pre-School?
Preferred days
Name of Parent/s
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: