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Phone: (02) 49 430 520

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Parent/Carer First Name

Parent/Carer Last name

Street Address

City

Region/State/Province

Postal / Zip code

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Phone

Relationship to Child

Child's Name

Date of Birth

Days required

Monday

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Wednesday

Thursday

Friday

Preferred Start Date

Does your child identifty as: * Required

Aboriginal

Torres Strait Islander

Aboriginal and Torres Strait Islander

Not Aboriginal or Torres Strait Islander

Do you hold a health care card from Services Australia: *

Yes

Will your child attend another service during their enrolment? *

Yes

If yes, where?

Is your child immunised? *

Yes

Medical Exemption

Does your child have medical needs or a disabilty?

Additional Information

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Call Us: (02) 49 430 520 / admin@feltonst.org.au / 74 Felton Street, Gateshead, NSW. 2290

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