Waitlist | Kinderhaus

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0456 713 231

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Child's Details

First name*

Surname*

Gender*

Male

Female

TBC

Date of Birth*

Preferred Start Date

Preferred Days

Monday

Tuesday

Wednesday

Thursday

Friday

Are you flexible with the days selected above?

Primary Parent/Carer's Details

First Name*

Surname*

Relationship to Child

Phone or Mobile*

Email*

Address

Secondary Parent/Carer's Details

First Name

Surname

Phone or Mobile

Child's Personal Information

Does your Child have a Disability, Speech Delay, Additional Need (i.e. Behavioural Concerns)

Comments

Does your child speak English

What is the main language spoken at home?

Any children in your family who have/or are attending our Service?

Children's Names

Is your child of Aboriginal or Torres Strait Islander descent and recognised as such by the community?

Children who are not Vaccinated or have not provided Vaccination Records may be excluded in the event of a Vaccine Preventable Disease. Is your Child's Immunisation up to date?

Additional Information

Please notify us immediately if any of the above information changes in any way. (Failure to do so may result in loss of position on waiting list). We have a firm commitment to protecting the privacy of our clients. Personal information collected on this form is for the purpose of contact and establishing priority of access only.

Kinderhaus Montessori Waitlist

Contact

info@kinderhaus.com.au
0456 713 231

Location

77 Burdett St, Hornsby NSW 2077, Australia

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