Kinburra Preschool Waiting List

Kinburra Preschool

Waiting List
We are licensed to cater for 3-6 year olds. Your child must be 3 before being Eligible to start.
CHILD'S NAME:*
DOB:*

DayMonthYear
Date
Gender:*

GirlBoy
BIRTH COUNTRY:*

Is your child immunised? Yes Or No*

YesNo
Has your child ever attended or do they currently attend other children's services such as Yarran Early Intervention Centres, Speech Therapy, Kid's on the Coast etc?*

YesNo
If yes, which?
Is your child currently taking regular medication for conditions such as Asthma, Diabetes, A.D.D, A.D.H.D, Epilepsy or other Medical Conditions?*

YesNo
If yes, which?
Please tick the following if applicable:

Health Care CardCultural & Linguistic Diversity (CALD)Aboriginal / Torres Strait Islander

Please choose the day(s) you wish your child to attend (please tick):*

MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAY

How did you hear about our Preschool?*
Signature
Date

DayMonthYear
Date
Unit 7/20-22 Kincumber Street

Kincumber

PO Box 6066 Kincumber. 2551
Tel: (02) 4369 2460

Email: kinburra@bigpond.com

Web: www.kinburrapreschool.com.au
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