Book a Tour Home » Book a Tour "*" indicates required fields Child's DetailsFirst Name** First Surname** Last Gender** Male Female Other Date of Birth** MM slash DD slash YYYY Preferred Start Date MM slash DD slash YYYY Preferred Days Monday Tuesday Wednesday Thursday Friday Select AllAre you flexible with the days selected above? Yes No Primary Parent/Carer's DetailsFirst Name** First Surname* Last Relationship to Child*MotherFatherGuardianOtherFamily/FriendPhone or Mobile*Email* Address Street Address Secondary Parent/Carer's DetailsFirst Name First Surname Last Phone or MobileChild's Personal InformationDoes your Child have a Disability, Speech Delay, Additional Need (i.e. Behavioural Concerns) Yes No Comments Does your child speak English Yes No What is the main language spoken at home? Any children in your family who have/or are attending our Service? Yes No Children's Names Is your child of Aboriginal or Torres Strait Islander descent and recognised as such by the community? Yes No 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? Yes No Additional InformationPlease 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.
