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Family Name

Child's Full Name

Date of Birth

Year of commencement

Gender

First Preference

4 Day Fortnight Kindergarten Group A (Every Mon & Tues - 8.30am to 4.00pm)

4 Day Fortnight Kindergarten Group B(Every Thurs & Fri 8.30am to 4.00pm)

5 Day Fortnight Kindergarten Group B (alt Wed & Every Thur & Fri - 8.40am to 2.50pm)

Any of the above

Second Preference

4 Day Fortnight Kindergarten Group A (Every Mon & Tue - 8.30am to 4.00pm)

4 Day Fortnight Kindergarten Group B (Every Thur & Fri - 8.30am to 4.00pm)

5 Day Fortnight Kindergarten Group B (alt Wed & Every Thur & Fri - 8.40am to 2.50pm)

Any of the above

Would you like to be considered for Junior Kindergarten?

Yes

No

Additional needs

Yes - please provide details in box below

No - please put N/A in box below

Please provide details:

Parent / Guardian 1 Last Name

Parent/Guardian 1 First Name

Parent/Guardian 1 Date of Birth

Parent / Guardian 2 Last Name

Parent/Guardian 2 First Name

Parent/Guardian 2 Date of Birth

Address

City

State

Post Code

Contact Phone

Email Address

How did you hear about our Vera Lacaze?

Application Fee- Please email receipt of payment to enrol@veralacaze.com.au to enable processing of application form

Waitlist Application