Miranda Kindergarten Waiting List

Child's Name*

First NameLast Name
Sex*

MaleFemale
Date of birth of child
DD / MM / YYYY
Address*

Street Address

Street Address Line 2

CityState

Postcode
Aboriginal / Torres Strait Islander*

YesNo
Nationality
Language spoken at home
Parent/ Carer 1
Parent / Carer 1

First NameLast Name
Home Number
Mobile Number
Work Number
Email address
example@example.com
Is the home address the same as the child (filled in above)?

YesNo
Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Occupation
Nationality
Language spoken
Parent / Carer 2
Parent / Carer 2

First NameLast Name
Home Number
Mobile Number
Work Number
Email address
example@example.com
Is the home address the same as the child (filled in above)?

YesNo
Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Occupation
Nationality
Language spoken
Does your child have any additional needs?
Are you a refugee or migrant?

YesNo
When did you arrive in Australia?
Do you hold a Family Health Card or Pension Concession Card?

YesNo
How did you find out about Miranda Kindergarten?
Signature

Clear
Please note: There is a $10 waitlist fee per child.
Once you click the submit button below, you will be taken to a payment gateway to enable you to pay this fee.

If you have a low income pension/health care card, the fee is not required.
Should be Empty:

Parent/ Carer 1