Childs Name First Last Date of Birth Date Format: MM slash DD slash YYYY GenderFemaleMaleChilds Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent / Carer (1)Name First Last Residential Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Do you need to register a second parent /carer? Yes Parent / Carer (2)Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Is there a shared custody arrangement? Yes Section 1My child will be attending Kindy (Pre-prep) at Borilla Community Kindergarten in 2021. Please number boxes 1-6 with 1 being your first choice. My group preferences are;4 Day fortnight. Mon/Tues - Mon/Tues 8am to 3.30pm4 Day fortnight. Thurs/Fri – Thurs/Fri 8am to 3.30pm5 Day fortnight. Mon/Tues/Wed – Mon/Tues 8.30am to 2.45pm5 Day fortnight. Thurs/Fri – Wed/Thurs/Fri 8.30am to 2.45pm6 Day fortnight. Mon/Tues/Wed – Mon/Tues/Wed 9am to 2.30pm6 Day fortnight. Wed/Thurs/Fri – Wed/Thurs/Fri 9am to 2.30pmI am interested in Before & After Care Kindy Care – 7am to 5.30pm on Kindy days Yes Additional NeedsMy child has been diagnosed with an additional need. Please give details below Yes Additional needs detailsMy child is suspected of having additional needs but has not yet received a diagnosis. Yes My child attends Emerald North ECDP. Yes My child identifies as Aboriginal / Torres Strait Islander / Australian South Sea Islander. Yes My child has a Health Care Card / Concession Card. Yes Section 2My child will NOT be attending Borilla Kindergarten (Pre-Prep) at Borilla Kindergarten in 2021. Not Attending Signature