Contact

Parent/guardian name*

Child's date of birth*

Preferred start date*

What days and times work best for a center tour?*

Any additional information you would like to provide?*

Parent/guardian name*

Child's date of birth*

Preferred start date*

What days and times work best for a center tour?*

Any additional information you would like to provide?*

Languages spoken at home:*

Known disabilities, diagnosis, allergies or illnesses:*

Child Care Requirements

No. Of Days Required:

Parent/Guardian Information

Title / First name:*

Are you any of the following:

Additional Information

It is your responsibility to notify us of any changes to the information supplied. Some changes to circumstances may affect your chances of being offered a placement within our centre. By filling out this form, your child’s name will go on the Waiting List. You will be contacted when a suitable position becomes available. This form does not guarantee that you will be offered a position.

Declaration

The information I have supplied within this form is to the best of my knowledge, true and correct and I will inform the centre if any changes occur.

Signature*

Please use a mouse or stylus to sign name

We invite you and your family to begin the enrolment process at Wallalong Preschool.

Call us on 02 4930 5339 to schedule a tour today!

Location

Hours

Approved Provider