Date of Application

Date of Birth

Child's Name


Parent's (Guardian's) Names:


Contact Information

Wish to register for: (Please indicate your preferences and intended year of entry)

3 Year Old Preschool

4 Year Old Preschool

Anticipated year of entry to Primary school

Has your family had any other children attend Gardiner Preschool? (Please detail)

Does your child have any special needs (e.g. language delay, developmental difficulties)?

* Do you hold a Health Care Card or Special Visa? (Please Advise Type)

Is your child of Aboriginal or Torres Strait Island descent?

Is your child currently attending one of the following?

(Please name the centre)


3 Year Old Preschool

4 Year Old Preschool