Waiting List Application 1Family Details2Confirmation and Payment Family Name* Last No of Guardians*12Primary Guardian* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Date of Birth: Primary Guardian* DD slash MM slash YYYY Secondary GuardianSecondary Guardian* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Contact DetailsHome Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Contact Phone Number*Email* Enter Email Confirm Email Child DetailsNumber of Children to Enrol*1234Name: Child 1* First Last Child 1: Gender* Male Female Date of Birth: Child 1* DD slash MM slash YYYY Year of Kindy- Only select the box where your child's date of birth falls. If you are wanting to add your child to our waiting list for 2024 you need to call the Kindy office. Do not fill out this form.* 2026 Born 1st July 2021-30th June 2022 2027 Born 1st July 2022-30th June 2023 2028 Born 1st July 2023-30th June 2024 2029 Born 1st July 2024 - 30th June 2025 You can only select the box that corresponds to your year of Kindy. Children are only funded for kindy for the year before they start prep.Child 2Name: Child 2* First Last Child 2: Gender* Male Female Date of Birth: Child 2* DD slash MM slash YYYY Year of Kindy- Only select the box where your child's date of birth falls. If you are wanting to add your child to our waiting list for 2024 you need to call the Kindy office. Do not fill out this form.* 2025 Born 1st July 2020-30th June 2021 2026 Born 1st July 2021-30th June 2022 2027 Born 1st July 2022-30th June 2023 2028 Born 1st July 2023-30th June 2024 You can only select the box that corresponds to your year of Kindy. Children are only funded for kindy for the year before they start prep.Child 3Name: Child 3* First Last Child 3: Gender* Male Female Date of Birth: Child 3* DD slash MM slash YYYY Year of Kindy- Only select the box where your child's date of birth falls. If you are wanting to add your child to our waiting list for 2024 you need to call the Kindy office. Do not fill out this form.* 2025 Born 1st July 2020-30th June 2021 2026 Born 1st July 2021-30th June 2022 2027 Born 1st July 2022-30th June 2023 2028 Born 1st July 2023-30th June 2024 You can only select the box that corresponds to your year of Kindy. Children are only funded for kindy for the year before they start prep.Child 4Name: Child 4* First Last Child 4: Gender* Male Female Date of Birth: Child 4* DD slash MM slash YYYY Year of Kindy 2025 Born 1st July 2020-30th June 2021 2026 Born 1st July 2021-30th June 2022 2027 Born 1st July 2022-30th June 2023 2028 Born 1st July 2023-30th June 2024 Support Requirements (Tick any that apply). My Child(ren)/Family has a Health Care Card. (Funding Support is available for Children or Families with a Health Care Card/Pension Card/Concession Card). My child(ren) identifies as Aboriginal/Torres Strait Islander. (Funding support is available for children who identify with these groups). My child is accessing additional support services. Please tick any supports your child is accessing or feel should be accessing. Paediatrician Speech Therapy Occupational Therapy Emerald North ECDP Bushkids NDIS Plan Other - Please comment Please Comment- Other FeesWaiting List Fee (1 Child) Price: This fee must accompany this application. Preference for groups is offered according to date of receipt of completed form and fee. The waiting list fee can be paid online at the completion of this form.Waiting List Fee (2 Children) Price: This fee must accompany this application. Preference for groups is offered according to date of receipt of completed form and fee. The waiting list fee can be paid online at the completion of this form.Waiting List Fee (3 Children) Price: This fee must accompany this application. Preference for groups is offered according to date of receipt of completed form and fee. The waiting list fee can be paid online at the completion of this form.Waiting List Fee (4 Children) Price: This fee must accompany this application. Preference for groups is offered according to date of receipt of completed form and fee. The waiting list fee can be paid online at the completion of this form.Total $ 0.00 Section Break Δ
