First Name:
Enrolment Waiting List

Umina: (02) 4344 4000

Address: 4 Nowack Ave Umina, N.S.W 2257


Child Name
Middle Name:
Last Name:
Male
Female
Gender:
DOB / Expected DOB
CRN:
e.g. 302476398X
Day Requested:
Any days
Monday
Tuesday
Wednesday
Thursday
Friday
Preference of days:
Preferred start date
First Name:
Middle Name:
Last Name:
Male
Female
Gender:
DOB
CRN:
Priority of access
These are the enrolment priority of access guidelines of the Federal Government. Please tick the box that applies to you and your child.
Priority 3: any other child
Within these main Priority categories, priority will also be given to children in:
- Aboriginal and Torres Strait Islander families
- families which include a disabled person
- families on lower incomes
- families from culturally and linguistically diverse backgrounds
- socially isolated families
- single parent families
Priority 2: a child of single parent who satisfies, or of parents who both satisfy, the work, training, study test
Priority 1: a child at risk of serious abuse or neglect
Parent
(dd/mm/yyyy)
e.g. 302476398X
Address:
Suburb:
State:
Postcode:
Home Phone:
Work Phone:
Mobile:
Email:
Anaphylaxis
Has your child been diagnosed at risk of Anaphylaxis?:
Yes
No
Does your child have
Yes
No
Any allergies: eg. food, medication, animals, insects?
Yes
No
Any special dietary requirements?
Yes
No
Any problems with hearing, sight, speech?
Yes
No
Any health problems, operations, illnesses, disabilities?
Yes
No
Does your child take any regular medication?
Yes
No
Does your child have a physical disability or delay, including intellectual, sensory or physical impairment?