Dubbo West Preschool Wait List Form

Address

Address

Home Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Mobile Phone

Area Code Phone Number
Occupation
Are you or your child of Aboriginal or Torres Strait Islander background?

Yes No
Are you or your child from a country other than Australia?

Yes No
Do you hold a Health Care Card?

Yes No
Does your child have any special needs? If Yes please provide details in the details section below.

Yes No
Details
Has your child had a sibling attended Dubbo West Preschool?

Yes No
If yes, siblings name and year attended
Does your child attend any other early childhood service at present?

Yes No
Should be Empty: