Enrolment Waiting list Application
Please complete the following form to enrol your child in our waiting list program.
Child's Surname:
Child's Given Name:
Expected Year of Enrolment:
Date of Birth:
*
-
Month
-
Day
Year
Date
Place of Birth:
Gender:
*
Female
Male
Pronouns:
She/Her
He/Him
They/Them
Aboriginal or Torres Strait Islander?
*
Yes
No
Immunisation Status:
*
AIR History Form
AIR Medical Exemption
Parent/Carer Details:
Surname:
Given Name/s
Holder of a Commonwealth Benefits Health Care Card?
*
Yes
No
Gender:
*
Male
Female
Non Binary
Pronouns:
She/Her
He/Him
They/Them
Email:
Phone Number
-
Area Code
Phone Number
Secondary Parent/Carer:
Surname:
Given Name/s:
Gender:
*
Male
Female
Non Binary
Pronouns:
He/Him
She/Her
They/Them
Email:
Phone Number:
Address: (Child's Primary Address)
Sibling Details:
Name of Sibling: n.a
DOB:
-
Month
-
Day
Year
Date
Previously Attended Periwinkle:
Yes
No
Name of other Sibling:
DOB:
-
Month
-
Day
Year
Date
Previously Attended Periwinkle:
Yes
No
Home Life
Will your child be in any other form of care whilst attending Periwinkle? If yes, please detail where & the number of days attending.
What is your understanding/experience with the Steiner Philosophy:
*
What does your child's Daily Rhythm look like at home?
What is your families stance on TV/Screen Time? How much TV/Screen Time does your child have?
*
Attendance / Fees:
Signature
Please supply your preferred days for your child to attend Periwinkle. Please note that your child must attend 5 days fortnight on consecutive days and preference will be given to 4-year olds. That is children turning 4 before 31st of July the year of enrolling.
*
Wattle - Monday, Tuesday (Alternate Wednesday)
Banksia - Thursday, Friday (Alternate Wednesday)
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Waiting List Fee
$30.00 AUD
$
30.00
AUD
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$0.00 AUD
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Name:
Date:
*
-
Month
-
Day
Year
Date
Submit
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