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Philosophy
Program
People
Enrolment
Gallery
Resources
Contact
FAQs
Enrolment Waiting List Application
ENROLMENT WAITING LIST APPLICATION
Please complete the following form to enroll your child in our waiting list program.
Your Child’s Details
Expected Year of Enrolment
*
Surname
*
Given Names
*
Date of Birth
*
Place of Birth
*
Gender
*
Female
Male
Aboriginal Australian or Torres Strait Islander?
*
Yes
No
Holder of a Commonwealth Benefits Health Care Card?
*
Yes
No
Immunisation Status
*
AIR History Form
AIR Medical Exemption
Parent/Guardian Details
Surname
*
Given Name/s:
*
Email:
Phone Number:
*
Surname:
*
Given Name/s:
*
Email:
Phone Number:
*
Address (Child’s primary residence):
*
Enrolment Details
Please list any siblings. Please tick the box if they have previously attended Periwinkle.
Name of sibling:
DOB:
Previously attended Periwinkle
Yes
Name of sibling:
DOB:
Previously attended Periwinkle
Yes
Name of sibling:
DOB:
Previously attended Periwinkle
Yes
Will your child be attending any other form of care whilst at Periwinkle? If yes, please detail where and no. of days attending.
*
Preferred Days
Please rank your preferred days for your child to attend Periwinkle. Please note that your child must attend 5 days a fortnight on consecutive days and preference will be given to 4-year old’s. That is children turning 4 before 31st July in the year enrolling.
Please Indicate preferred days
*
Monday & Tuesday alt Wednesday
Thursday & Friday alt Wednesday
Account name: Periwinkle Preschool
BSB: 082-489
Account #: 570447998
Please tick this box to indicate you have transferred the $30 waiting list application fee.
*
Yes
Name:
*
Signature:
*
Date:
*
Submit
If you are human, leave this field blank.