Child's Eye Colour*
Child's Hair Colour*
Child's Skin Colour/Ethnicity*
Attach Photo of Child
Health Care #
In case of accident, injury or illness, i authorize to contact a physician and/or ambulance and to seek medical attention for my child. I also consent for my child to be transported by ambulance or in a staff vehicle to obtain medical attention.
Languages spoken at home
Person to call in case of accident (other than parents listed above)
Persons authorised to pick up child from facility (other than parent/guardian)
Relationship to child
Personal Health Number
Child Immunization YesNo
Illness or Medical Treatments
Is there anyone not permitted to pick up your child?
Adults at home
Child's previous experience in a playgroup?
Child's special likes
What do you hope your child will gain from preschool?
If there is a custody agreement, please give details. A copy of the custody order must be left with the preschool staff.
Would you like some information about Preschool Subsidy for Fees? YesNo