Child's Name
*
First Name
Last Name
Sex
*
Male
Female
Date of birth of child
DD / MM / YYYY
Address
*
Street Address
Street Address Line 2
City
State
Postcode
Aboriginal / Torres Strait Islander
*
Yes
No
Nationality
Language spoken at home
Parent/ Carer 1
Parent / Carer 1
First Name
Last Name
Home Number
Mobile Number
Work Number
Email address
example@example.com
Is the home address the same as the child (filled in above)?
Yes
No
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Occupation
Nationality
Language spoken
Parent / Carer 2
Parent / Carer 2
First Name
Last Name
Home Number
Mobile Number
Work Number
Email address
example@example.com
Is the home address the same as the child (filled in above)?
Yes
No
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Occupation
Nationality
Language spoken
Does your child have any additional needs?
Are you a refugee or migrant?
Yes
No
When did you arrive in Australia?
Do you hold a Family Health Card or Pension Concession Card?
Yes
No
How did you find out about Miranda Kindergarten?
Signature
Submit
Should be Empty: