Name How to complete this form: Please indicate whether this form is a new application or an amendment to an existing application by ticking the applicable box below. A range of information is gathered for legislative and statistical purposes - please ensure you complete all sections of this form to help us process your application as soon as possible. IMPORTANT NOTE: Lodgement of this form does not guarantee your child a place at Camira C&K Kindergarten. This form is a Waiting List application form ONLY. Camira Kindergarten does not have a sibling policy; you must complete a separate form for each child. Application type New Application New Application Amendment to Existing Application Your child's details Child's given name * Child's family name * Child's address * Suburb, Postcode Home phone number * Country of birth * Date of birth * Child's gender * Male Female Child's first language * Main language spoken at home Child's second language Is your child of Aboriginal descent? * Yes No Is your child of Torres Strait Island descent? * Yes No Parents/Guardians details Parent / Guardian 1 Details Given Name and Surname Home Phone Mobile Phone Work Phone Relationship to child Email address If a parent's home address is different to that of the child's, please complete Parent / Guardian 2 Details Given Name and Surname Home Phone Mobile Phone Work Phone Relationship to child Email address If a parent's home address is different to that of the child's, please complete Do you or your child hold a current Health Care Card? * Yes No Year of commencement Please tick the box * 2018: Child born between 01 July 2013 – 30 June 2014 2019: Child born between 01 July 2014 – 30 June 2015 2020: Child born between 01 July 2015 – 30 June 2016 2021: Child born between 01 July 2016 – 30 June 2017 2022: Child born between 01 July 2017 – 30 June 2018 2023: Child born between 01 July 2018 – 30 June 2019 APPLICATION DETAILS The information you provide in this section will assist C&K Camira to facilitate a smooth transition for your child into our Kindergarten service. All responses to these questions are voluntary and will be treated in accordance with the C&K confidentiality and privacy policy. Is your child undergoing assessment for any of the conditions listed below? * Yes No Has your child been diagnosed with any of the conditions listed below? * Yes No If yes, please tick condition/s below: Any allergic condition Asthma Attention deficit disorder (ADD/ADHD) Autistic Spectrum disorder Behavioural issues Diabetes Epilepsy Speech/language delays If yes to one or more of the conditions above, please complete the details below: Parents/Guardians Work Status Parent/Guardian 1 * Working Full Time / Part Time Studying Full Time / Part Time Seeking Work Stay at Home Duties Other Parent/Guardian 2 * Working Full Time / Part Time Studying Full Time / Part Time Seeking Work Stay at Home Duties Other How did you find out about Camira C&K Kindergarten? find out Word of mouth Existing C&K Service C&K Website Yellow Pages White Pages Facebook School Flyer / Brochure Other If other please give details below Acknowledgement: Name of person lodging this form * Date Contact number/s * Preferred Email Address * WHAT HAPPENS NOW? The Kindergarten will send a confirmation email to let you know that the form has been received. We may also contact you to discuss your application and clarify some details. We will contact you should a place become available. Please advise Camira Kindergarten should any of your contact details change. Enrolment offers for the following year are conducted in July/August of the previous year. Positions are offered according to the date that the waiting list form was received and confirmed by the Kindergarten Directors.
