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1. About your child

Name*

First Middle Last

Gender

F
M
Other

D.O.B*

Residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Language spoken at home

2. Enrolment Details

Choice of Campus

Day Preference (minimum 2 days per week attendance)

Monday
Tuesday
Wednesday
Thursday
Friday

Enrolment Year

Children are required to be 3 years of age

Inquire5 Enrichment Program

Children are required to be 4-5 years of age (available at Battery Point Campus only)

Yes
No

3. Parent/Guardian Information

Parent/Guardian 1

Name*

Prefix First Last

Residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Relationship to child

Occupation

Place of employment

3a. Parent/Guardian Information

Parent/Guardian 2

Name

Prefix First Last

Residential address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Email

Relationship to child

Occupation

Place of employment

4. Child Health Information

Does your child suffer from any known allergies/anaphylaxis?

Yes
No

Please provide relevant details below including your child's allergy, side effects, treatment and action:

Does your child have a diagnosed disability or special rights?

Yes
No

Please provide relevant details below:

Does your child have any additional requirements?

Yes
No

Please list any additional information below:

Is your child fully immunised?

Yes
No

5. Custody & Access

Are there any court/parenting orders relating to the custody and/or access to the child?

If yes, please provide a copy of all relevant documentation upon commencement of enrolment.

Yes
No

6. Priority of Access

New Horizons Preschool follows the Priority of Access guidelines determined by the Australian Government. These guidelines set out levels of priority which services must follow when filling vacant spaces. The information requested below enables us to follow these guidelines correctly.

My child's priority area is:

Priority 1 - child at risk of serious abuse or neglect
Priority 2 - child from a family that satisfies the work / training / study test
Priority 3 - any other child

My child is from:

An Aboriginal or Torres Strait Islander Family
A family on a lower income
A socially isolated family
A family which includes a disabled person
A culturally & linguistically diverse family
A single parent family

7. Declaration

I/We declare that all information provided in this application is accurate. I agree to notify New Horizons Preschool immediately should there be any change to this information. In the event of a place being offered to my child, I agree to adhere to the conditions of enrolment, procedures and practices of New Horizons Preschool, and the responsibility for paying fees as they fall due.

Name

This field is for validation purposes and should be left unchanged.

1. About your child

2. Enrolment Details

3. Parent/Guardian Information

3a. Parent/Guardian Information

4. Child Health Information

5. Custody & Access

6. Priority of Access

7. Declaration

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