Please complete the following form to be added to our waiting list.

"*" indicates required fields

CHILD DETAILS

Child's Name*
Child's date of birth / expected date of birth*

PARENT/CARER DETAILS

Parent/Carer's Name*
Please provide your home/mobile number
Address*

2nd Parent/Carer's Name
Please provide your home/mobile number
Address

ENROLMENT PREFERENCES

Preferred Days of Enrolment*
Preferred commencement date*

ADDITIONAL INFORMATION

(This information is collected to determine priority of access according to Government Legislation and enrolment policy)
If you have an NDIS plan/number, please provide.