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Little e's Kindergarten
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Little e's Kindergarten
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STUDENT DETAILS
Surname
First Name/s
Date of Birth
Male / Female
Male
Female
Address
Country of Birth
Does your child identify as Aboriginal or Torres Strait Islander
YES
NO
Languages spoken at home, in order of preference
Child's Centrelink Reference Number
PARENT 1 DETAILS (Claimant for Centrelink)
Full Name
Date of Birth
Address
Email (for all correspondence - accounts, newsletters etc)
Home Phone
Mobile Phone
Parent's Centrelink Reference Number
Country of Birth
Cultural Background
Occupation
Workplace
Languages spoken
Interpreter required
Yes
No
PARENT 2 DETAILS
Full Name
Date of Birth
Address
Email Address
Home Phone
Mobile number
Parent's Centrelink Reference Number
Country of Birth
Cultural Background
Occupation/Studying
Workplace
Languages spoken
Interpreter required
YES
NO
FAMILY INFORMATION
Church Details - Is the family actively involved with a Christian Church?
Is the family actively involved with a Christian Church?
YES
NO
Church Name and Address
Minister's Name
PREFERRED DAYS AND SESSIONS
Our preference is a minimum of 3 days per week
Monday
Tuesday
Wednesday
Thursday
Friday
Five-day Fortnight
Yes
No
Preferred Sessions: We operate 50 weeks per year between 7am and 6pm.
10 hours 7.30am - 5.30pm
11 hours 7.00am - 6.00pm
PARENTING ARRANGEMENTS
Is there a current Parenting Order in place
YES
NO
FAMILY SITUATION AND SIBLINGS
Child lives in a family situation with
Two natural parents
Mother only
Father only
Grandparents
Other
Other Details
Are there siblings currently attending Emmanuel College?
YES
NO
Name of Siblings and Year Level
List other relationships your family has had with Emmanuel College
Sibling
Staff member
Alumni - enter graduating year below
Graduating Year
PREVIOUS CARE
Has your child attended an education and care service (Child Care) previously
YES
NO
Has your child previously completed a year in an approved Kindergarten (Pre-Prep) program?
YES
NO
Frequency of attendance (please include days and hours)
Centre Name
Centre contact name
Centre contact number
CHILD HEALTH AND DEVELOPMENT
Birth history that may affect child's development
Has your child had any of the following: (If yes, please provide details below)
Disease
Surgery
Recurring Illness
Accident
Hospitalisation
Does your child have a:
Physical disability
Learning delay
Other
Has your child been assessed by any of the following specialists: (if yes, please provide details below)
Speech Therapist
Occupational Therapist
Physiotherapist
Psychologist
Psychiatrist
Specialist Clinic
Audiologist
Paediatrician
Dietician
Optometrist
Other
Enter further details here (please include all relevant information)
IMMUNISATION
Is your child fully immunised (Child must be fully immunised to be eligible for Centrelink benefits)
YES
NO
ENROLMENT AGREEMENT
I/We acknowledge that all information is true and accurate with regard to developmental status in the following areas: learning, behavioural, social, emotional, physical, psychological and self care.
YES
NO
I/We understand that enrolment at the Centres does not guarantee a future position at Emmanuel College. I/We acknowledge that a separate application must be made for enrolment into Prep at Emmanuel College.
YES
NO
Fields with a * are required
Submit your Application