WTPS Attendance Application Form

WILLIAMTOWN PRE SCHOOL INC.
20A Kangaroo Steet, Raymond Terrace NSW 2324

PO Box 5014, Raymond Terrace East NSW 2324

Phone: 02 49 877009 Email: wlmpres@bigpond.com
ATTENDANCE APPLICATION FORM
Child's Surname*
First Name*
Birth Date*

DayMonthYear
Gender*

FemaleMale
Age
Day/s Interested:

MondayTuesdayWednesdayThursdayFriday
HRS: 8:30am - 4:00pm
Date Pre School is Required

DayMonthYear
(Note; it may not be possible for your child to commence on this date).
Aboriginal / Torres Strait Island Descent:

YESNO
Low Income Health Care Card Holder:

NOYES
HCC No:
EXP Date

MonthDayYear
Year your child is to start Kindergarten*

MonthDayYear

Siblings:

Contact Numbers:

	Home	Mobile	Work
Phone

Contact Numbers:

	Home	Mobile	Work
Phone

Employer:
Occupation
E-mail
Other Infomation
Has your child been diagnosed with a DISABILITY?

YesNo
(We may be able to apply for funding to assist your child's needs)

(Please attach copies of reports and documentation)
Details of Condition
Have you any Additional Needs?*

YesNo
If Yes comment.
Have any PHYSICAL / MEDICAL or SPEECH concerns?

YesNo
If Yes comment.
Have any BEHAVIOURAL issues?

YesNo
If Yes comment.
ALLERGIES

YesNo
If Yes comment.
EpiPEN Required?*

YesNo
Is your child attending another Centre?*

YesNo
If YES what centre Name?
Should be Empty:

WILLIAMTOWN PRE SCHOOL INC.