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* 1. Parent/Guardian name? (First and last please)

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* 2. Child's name? (First and last please)

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* 3. Child's date of birth?

Date / Time

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* 4. Parent email address?

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* 5. If your child is attending Preschool/Kinder, what is the name of the centre? (If not applicable please type N/A.)

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* 6. Who is their teacher? (If not applicable please type N/A.)

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* 7. If your child is attending a child care centre, which one? (If not applicable please type N/A.)

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* 8. Who is their Teacher? (If not applicable please type N/A.)

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* 9. Child Care Centre / Kinder phone number?

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* 10. Is your child currently receiving funding to support his/her development?

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* 11. If yes, please provide details?

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* 12. Does your child have any medical conditions? (If not applicable please type N/A.)

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* 13. If yes, please provide details?

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* 14. Does your child speak a language other than English at home?

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* 15. If yes, please provide details of which language and an estimated percentage it is spoken outside of preschool hours? i.e. Japanese 70% English 30% 
(If not applicable please type N/A.)

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* 16. Does your child have an identified developmental delay? i.e. Speech.

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* 17. Please provide the names of four (or more) friends your child could be placed with? If appropriate include both boys and girls. (Please note whilst all efforts will be made to accommodate placement of your child with his/her friends, it may not be practicable to group your child with all the friends you list.)

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* 18. Please provide the name and age of any siblings? (If not applicable please type N/A.)

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* 19. Transitioning child's position in family? i.e. Middle child, eldest child etc...

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* 20. Your child lives with? (please tick)

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* 21. Please list some of your child's interests?

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* 22. How would you describe your child's personality? i.e. Outgoing, shy, confident, sensitive etc...

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* 23. Please provide examples of any particular situations that may cause anxiety for your child?  i.e. sensitivity to noise, worries etc...

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* 24. Please advise of any worries or concerns you had at Preschool / Child Care, if any? (If not applicable please type N/A.)

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* 25. Please provide any other information you feel is significant to support your child with a positive start to school?

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* 26. Would you like to include your email address and/or phone number on our 2020 Foundation parent contact list? This list is provided to parents towards the end of the year to help facilitate play dates over the summer holiday break.
If you would like your contact details to be included on this list, please tick the box below and enter the email and/or phone number you would like displayed.

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