*Stepping Stones Waitlist Form

Register your Interest
Child's Name

First NameLast Name
Child's Date of Birth

DayMonthYear
Date
Child's Date of Birth

MonthDayYear
Expected Start Date

DayMonthYear
Date
Preferred Days
Are you flexible above
Parent/Carers Name

First NameLast Name
Parent/Carers Date of Birth

DayMonthYear
Date
Phone Number
Please enter a valid phone number.Format: 0000000000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child have a Disability, Speech Delay, Additional Needs, or Behavioural Concerns? Please provide more information below.
Does your Child Speak English?
Allocation of available places is made in accordance with the Australian Government's Priority of Access Guidelines and other information gathered from you as part of this waitlist process. Please answer the following questions to ensure we can assess your waitlist accordingly.
Parent 1 Activity Information
Parent 1 Occupation
Parent 2 Activity information
Parent 2 Occupation
Any Children in your Family who have/or are attending our Service?
Please provide any extra information
Should be Empty:

Register your Interest