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Little e's Kindergarten
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Little e's Kindergarten
CHILD DETAILS
Child's First Name/s
Child's Surname
Date of Birth
Child's Centrelink Reference Number
Gender
Male
Female
Home Address
Country of Birth
Does your child identify as Aboriginal or Torres Strait Islander
Yes
No
Languages spoken at home, in order of preference
PARENT 1 DETAILS
First Name
Surname
Date of Birth
Address
Email (for all correspondence - accounts, newsletters etc)
Contact Number
Country of Birth
Cultural Background
Languages spoken
Interpreter required
Yes
No
Occupation
Workplace
Relationship with Emmanuel
Are you a current employee working at Emmanuel College?
Yes
No
Are you an Alumni of Emmanuel College?
Yes
No
If yes, please enter graduating year:
Please provide your surname as it was during your enrolment at Emmanuel College
PARENT 2 DETAILS
First Name/s
Surrname
Date of Birth
Address
Email Address
Mobile number
Country of Birth
Cultural Background
Languages spoken
Interpreter required
Yes
No
Occupation/Studying
Workplace
Relationship with Emmanuel
Are you a current employee working at Emmanuel?
Yes
No
Are you an Alumni of Emmanuel College?
Yes
No
If yes, please enter graduating year
Please provide your surname as it was during your enrolment at Emmanuel College
FAMILY INFORMATION
Church Details - Is the family actively involved with a Christian Church?
Yes
No
Church Name and Address
Minister's Name
Preferred Days (minimum of 3 days per week)
Monday
Tuesday
Wednesday
Thursday
Friday
Are you flexible with preferred days?
Yes
No
Notes regarding days of attendance / flexibility:
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
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
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
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
Medical Assessments
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
Please include any diagnosis and/or assessments: eg ASD, ADHD, Speech, Global Developmental delays, etc
Immunisation
Is your child fully immunised (Child must be fully immunised to be eligible for Centrelink benefits)
Yes
No
ENROLMENT AGREEMENT
Parent 1: I 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
Parent 2: I 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
Submit form