Waiting List Application

IMPORTANT NOTE: Our 2023 Waiting List is now closed.
Please discuss your situation by email prior to completing a waiting list application for a 2023 position.

Child's Details

Name *

First

Last

Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

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

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

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.

Preferred Payment Method:

• Electronic Funds Transfer: Elizabeth Chifley Preschool (BSB: 637 000 - ACC: 781 776 947)

Please use your child's name as payment reference

Submit Application