Enrolment Waiting List Application

Please complete the following form to enroll your child in our waiting list program.
Your Child’s Details
Gender *
Aboriginal Australian or Torres Strait Islander? *
Holder of a Commonwealth Benefits Health Care Card? *
Immunisation Status *
Parent/Guardian Details
Enrolment Details
Please list any siblings. Please tick the box if they have previously attended Periwinkle.
Previously attended Periwinkle
Previously attended Periwinkle
Previously attended Periwinkle
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 *
Account name: Periwinkle Preschool
BSB: 082-489
Account #: 570447998
Please tick this box to indicate you have transferred the $30 waiting list application fee. *