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Little e's Application for Enrolment

Home / Forms / Little e's Application for Enrolment

Applications for 2025 will close on Tuesday 30 April 2024 at 5.00pm.

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

Birmingham Road, Carrara
Queensland, Australia 4211

Call 07 5561 4000 | Fax 07 5561 4011
administration@emmanuel.qld.edu.au

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