*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
MaleFemale
Expected Start Date*

DayMonthYear
Date
Preferred Days*

MondayTuesdayWednesdayThursdayFridayFull Time
Are you flexible above*

YesNo
Parent/Carers Name*

First NameLast Name
Parent/Carers Date of Birth *

DayMonthYear
Date
Phone Number*
Please enter a valid phone number.
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.*

Aboriginal and Torres Strait IslanderFamily includes a disabled personIs the child at riskCare required for socialisationSingle parent familyNone of the above
Parent 1 Activity Information
Care required for workingCare required for Study
Parent 1 Occupation
Parent 2 Activity information
Care required for workingCare required for Study
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