Centre Enquiries

First name*

Last name*

Date of Birth (or expected DOB)*

Gender*

Does your child have any diagnosed disabilities or any other additional needs we may need to be aware of?*

Does your child identify as Aboriginal and/or Torres Strait Islander?*

Yes

Does your family have a Health Care Card?*

Yes

(provided by Centrelink - this is separate to a Medicare Card)

Health Care Card Number*

Is this child at risk of significant harm?*

Yes

If yes, please identify if you have a support worker or are working with another agency

Name of support worker or agency*

Does your child require any additional language supports relating to English?*

Yes

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