ELC Enrolment Questionnaire | Ballarat Clarendon College

Student surname*

Student given names*

Date of Birth*

Parent 1 name (Given and Surname)

Parent 2 name (Given and Surname)

Enrolment year*

Enrolment Year level*

Which term will you begin your enrolment with us?*

If you wish to start mid-term, please indicate the preferred commencement date

What is your preference for days in 2025?*

Please note this is a preference only based on current offerings. Actual group offerings for 2025 will not be confirmed until place offer stage.

Background Information

Who is in your child's family?*

Who else is important to them? (friends/pets etc)*

Was your child born at full term?*

Yes
No

Were there any complications at the birth of your child that may impact their development?*

Yes
No

If yes, please provide further details?

Was your child admitted to the special-care nursery?*

Yes
No

If yes, please provide further details?

Has your child had their Maternal Child Health checks?*

Yes
No

Were developmental milestones met?*

Yes
No
Some

If no/some please provide further details.

Do you have any concerns with your child's hearing or vision?*

Yes
No

If yes, please provide further details.

Has your child had a hearing test?*

Yes
No

Has your child had a eye test?*

Yes
No

Does your child have any ongoing illness or allergies?*

Yes
No

If yes, please provide further details.

Community

Has your child attended any early learning programs including child care, creche, baby sitting or kindergarten program?*

Yes
No

If yes, please state the name of facility.

How often did your child attend and for what hours?

Do you have any concerns about how your child separates from you?*

Yes
No

If yes, please provide further details.

Wellbeing

Does your child enjoy running, jumping and climbing?*

Yes
No

Do you have any concerns with how your child uses their hands and fingers?*

Yes
No

If yes, please provide further details.

Do you have any concerns with how your child uses their arms and legs?*

Yes
No

If yes, please provide further details.

Is your child left or right handed or still using both?*

Left
Right
Both

Communication

What is your child's first language?*

Does your child speak or understand any other languages?*

Yes
No

If yes, please list the language/s.

Can you easily understand what your child is talking about?*

Yes
No

If no, please give some detail.

Can other people easily understand what your child is talking about?*

Yes
No

If no, please give some detail.

Is your child involved with a speech pathologist?*

Yes
No