Waiting List Application

IMPORTANT NOTE:

This application registers your child on our waiting list, however does not guarantee or confirm placement. Once a position is available, you will be contacted using the information you have provided on this form.

Please ensure you enquire and apply at other services, as placement offers and class availability can never be guaranteed.

Child's Details

Name *

First

Last

Date of Birth *

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Gender *Please selectMaleFemaleNon Binary

Address *

Address Line 1

City

State / Province / Region

Postal Code

Nationality

Country of Birth

Religion

Language/s spoken at home

Is your child recognised as; *

• Aboriginal
• Torres Strait Islander
• Both Aboriginal and Torres Strait Islander
• Neither Aboriginal or Torres Strait Islander

2. Parent / Guardian Details

Parent 1

Name *

First

Last

Title

• Mr
• Mrs
• Ms
• Other

Relationship to Child *Select Relationship to ChildMotherFatherOther

Relationship to Child (Other):

Parent 1 Residential Address *

• Same as Child
• Other

Parent 1 Address

Address Line 1

City

State / Province / Region

Postal Code

Phone No: *

Alternate Phone No:

Email *

Background

• Aboriginal
• Torres Strait Islander
• Both Aboriginal and Torres Strait Islander
• Neither Aboriginal or Torres Strait Islander

Parent 2

Details of Parent 2?

• No further parent information avaliable

Name *

First

Last

Title

• Mr
• Mrs
• Ms
• Other

Relationship to Child *Select Relationship to ChildMotherFatherOther

Relationship to Child (Other):

Parent 2 Residential Address

• Same as Child
• Other

Parent 2 Address

Address Line 1

City

State / Province / Region

Postal Code

Phone No:

Alternate Phone No:

Email:

Background

• Aboriginal
• Torres Strait Islander
• Both Aboriginal and Torres Strait Islander
• Neither Aboriginal or Torres Strait Islander

Health / Medical / Development Information

Is your child named on a Government Issued Health Care / Pension Card? *

• Yes
• No

IMPORTANT: this question does NOT refer to a Medicare Card.

Health Care Card Number: *

Health Care Card Expiry: *

Do you or your doctor / health professional have any concerns with your child's development? *

• Yes
• No

Does your child have an NDIS plan?

• Yes
• No

Has your child ever attended Early Intervention?

• Yes
• No

Please provide more information:

Does your child suffer from allergies and/or asthma?

• Yes
• No

Please provide more information:

4. Acknowledgement of Waiting List Procedure

Parent Acknowledgement *

• I acknowledge completion of this application form and payment of waiting list processing fee is not a guarantee that my child will be offered a position at Elizabeth Chifley Presbyterian Preschool
• I acknowledge my child will remain on the waiting list until they are offered a place, I withdraw their application, or they are of the legal age where they must attend school
• I acknowledge it is my responsibility to advise Elizabeth Chifley Presbyterian Preschool if our contact details or personal circumstances change
• I acknowledge this application is not transferable between children / siblings and the waiting list processing fee is not refundable

Name of person completing application *

Date of application

Additional comments:

5. Payment of Waiting List Processing Fee

To confirm your application, payment of $20.00 Waiting List Processing Fee must be made at time of submission.

Payment Options: *

• Electronic Funds Transfer
• Credit Card / Apple Pay / Google Pay (via Stripe)

Payment directions will open after ‘Submit Appication’ is completed.

Waiting List Fee

Price: $ 20.00

Submit Application