Parent/Guardian Details- Kekeco Child Wait List Form
Early Childhood Education Service you need care.
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Dudley Street Childcare and Kindergarten
Ferguson Street Kindengarten and ELC
Sutherland Street Childcare and Kindergarten
Parent Guardian FIrst Name
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Parent Guardian Last Name
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Street Number and Name of Street
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Town/suburb where you live.
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Postcode of Suburb/Town where you live.
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Mobile Phone Number for main contact
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Email Address
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Relationship to Child (Choose One)
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Mother
Father
Guardian
Family /Friend
Foster Carer
Other
Child's Details
Child's First Name
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Child's Surname
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Date of birth/Expected arrival date
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Child's Gender
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Male
Female
To be confirmed
Days required*
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Monday
Tuesday
Wednesday
Thursday
Friday
Flexible with Days?
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Yes
No
Preferred Start Date?
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Is your child's Immunisation up to date?
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Yes
No
Is your child Aboriginal/Torres Strait Islander descent and recognised as such by the community?
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No
Yes
Does your child speak English ?
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Yes
No
Have any children in your family ever attended or are currently attending any of our services?
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Yes
No
Does your child have a disability, speech delay, additional need i.e. Behavioural Concerns
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No
Yes- Please add more information in the Comments Section so we can support your child appropriately
Do you have a current Low Income Health Care Card?
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No
Yes
Comments
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