2022 Preference Form – Borilla Community Kindergarten

Childs Name

First Last

Date of Birth

Gender

Childs 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

Phone

Email

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

Phone

Email

Is there a shared custody arrangement?

Yes

Section 1

My child will be attending Kindy (Pre-prep) at Borilla Community Kindergarten in 2022. Please number boxes 1-5 with 1 being your first choice. My group preferences are;

4 Day fortnight. Mon/Tues - Mon/Tues 8am to 3.30pm

4 Day fortnight. Thurs/Fri – Thurs/Fri 8am to 3.30pm

6 Day fortnight. Mon/Tues/Wed – Mon/Tues/Wed 9am to 2.30pm

6 Day fortnight. Wed/Thurs/Fri – Wed/Thurs/Fri 8.30am to 2pm

5 Day Week. Mon/Tues/Wed/Thurs/Fri 7am to 5.30pm

I am interested in Before & After Care Kindy Care – 7am to 5.30pm on Kindy days

Yes

Additional Needs

My child has been diagnosed with an additional need. Please give details below

Yes

Additional needs details

My 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 2

My child will NOT be attending Borilla Kindergarten (Pre-Prep) at Borilla Kindergarten in 2022.

Not Attending

Signature