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Enrolment Form

1. Information about the child

NOTE! if you leave a field blank please put N/A in the field

Gender:

Does your child attend pre-school/school/other service (e.g. Long Day Care):

Is your child of Aboriginal or Torres Strait Islander origin (please tick):

Religion ( if applicable):

Does the child have any special needs (please tick):

Is the child from (please select): A culturally & linguistically diverse background:

A refugee background who have been subjected to trauma:

The child’s place has been sought by a state or territory child protection worker:

The child is in care of the state, or other forms of out of home care:

Immunisation: All parents claiming Child Care Benefit for children must provide proof of immunisation to the DHS (Department of Human Services), or register as a conscientious objector. Please note that confirmation of immunisation needs to be given to the Family Day Care office upon enrolment and each time immunisation is updated. Is your child immunised (please tick):

Does your child have any allergies or sensitivities including asthma and/or anaphylaxis?:

Does your child have any medical conditions?

Does your child have any additional needs or disability?

Does your child have any dietary restrictions, sensitivities

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