Child details Does your child have any additional needs or a medical condition that may First name: require support? Surname/ No Yes (please provide details below) Family name: / / Date of birth: *Proof of age must be provided at time of enrolment Gender: Male Female Main Residential Address: (note that you may be requested to provide supporting documents of the residential address) child’s Address: Suburb/Town: Postcode: Please indicate the reason(s) for seeking placement at a preferred preschool (eg child care arrangements, transport) Mailing Address (if different from residential address) Intended School School name: Expected school commencement Year: Term: Is your child of Aboriginal or Torres Strait Islander origin? No Yes, Aboriginal Yes, Torres Strait Islander Is this child under the Guardianship of the Minister for Education and Child Development or in alternative care? No Yes Parent / Guardian details Please check the box on right for preferred method of communication Given name: Home phone: Family Mobile: name: Relationship Work phone: to child: Signature: Email: Date: Mailing address: (as above) Details of person completing form (if other than parent/ guardian ) Name: Relationship to child: / / Signature: Date: Office use only Anticipated preschool start date: Any other comments: Birth date range for eligible children Term Year 2017 2018 2019 Date: Parent/Guardian has confirmed enrolment? From 01/05/2013 01/05/2014 No Yes Date: To 30/04/2014 30/04/2015 Child resides in local catchment area? No Yes
Child details Does your child have any additional needs or a medical condition that may require support? No Yes (please provide details below) First name: Surname/ Family name: Date of birth: / / *Proof of age must be provided at time of enrolment Gender: Male Female Main Residential Address: (note that you may be requested to provide supporting documents of the child’s residential address) Address: Suburb/Town: Please indicate the reason(s) for seeking placement at a preferred preschool (eg child care arrangements, transport) Postcode: Mailing Address (if different from residential address) Intended School School name: Expected school commencement Year: Term: Is your child of Aboriginal or Torres Strait Islander origin? No Yes, Aboriginal Yes, Torres Strait Islander Is this child under the Guardianship of the Minister for Education and Child Development or in alternative care? No Yes Parent / Guardian details Please check the box on right for preferred method of communication Given name: Home phone: Family name: Mobile: Relationship to child: Work phone: Signature: Email: Date: Mailing address: (as above) Details of person completing form (if other than parent/ guardian ) Name: Relationship to child: Signature: Date: / / Office use only Birth date range for eligible children Anticipated preschool start date: Term Year Date: Parent/Guardian has confirmed enrolment? No Yes Date: Child resides in local catchment area? No Yes Any other comments: 2017 2018 2019 From 01/05/2013 01/05/2014 To 30/04/2014 30/04/2015
fulham_park_preschool_enrolment_registration_form.docx