Enrolment

Child's Name *

First Name

Last Name

Gender *

Male

Female

Date of Birth *

MM

DD

YYYY

Parent/Guardian1 Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (Parent/Guardian 1) *

(###)

###

####

Are you the holder of a Health Care Card or Pensioner Concession Card (where the child is a named dependent on the card), or a Veteran Card, issued by the Australian Government

Yes

No

Parent/Guardian2 Name

First Name

Last Name

Phone (Parent/Guardian 2)

(###)

###

####

Are you the holder of a Health Care Card or Pensioner Concession Card (where the child is a named dependent on the card), or a Veteran Card, issued by the Australian Government

Yes

No

Aboriginal/Torres Strait Islander *

Aboriginal

Torres Strait Islander

Neither ATSI

Priority of Access *

NSW State Government requires our service to follow the Priority of Access Guidelines. Please select if any of the following apply:

Child at risk of serious abuse or neglect

Child with disability

Low income family

Child from non-english speaking background

Single parent family

None of the above

Years Requested *

2025

2026

Preference of enrolled days *

*We have a minimum two day/week enrolment requirement. Please indicate preference of enrolment days below:

2 Days - Monday & Tuesday

2 days - Thursday & Friday

3 Days - Monday, Tuesday & Wednesday

3 Days - Wednesday, Thursday & Friday

4 Days - Monday, Tuesday, Thursday & Friday

5 Days- Monday to Friday

Required start date if part way through the year

MM

DD

YYYY

Additional information or particular needs of child *

Please indicate below if your child requires additional support in the following areas:

Disability

Diagnosis

Allergies/Anaphylaxis

Behavioural Concerns

Toileting concerns

Hearing concerns, language delay or Speech delay

None of the above - No additional support required