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Early Learning Centre enrolment questionnaire
Student surname
*
Student given names
*
Date of Birth
*
DD slash MM slash YYYY
Parent 1 name (Given and Surname)
Parent 2 name (Given and Surname)
Enrolment year?
*
2023
2024
Enrolment Year level
*
Three-Year-Old Early Learning
Four-Year-Old Early Learning
Which term will you begin your enrolment with us?
*
Term 1
Term 2
Term 3
Term 4
If you are wish to start mid-term, please indicate the commencement date
DD slash MM slash YYYY
What is your preference for days in 2024?
*
3YO ELC - 2 Days - Wednesday/Friday
3YO ELC - 3 Days - Monday/Tuesday/Thursday
4YO ELC - 4 Days - Monday to Thursday
4YO ELC - 4 Days - Tuesday to Friday
Please note this is a preference only based on current offerings. Actual group offerings for 2024 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 birth complications?
*
Yes
No
If yes, please provide further details?
Was your child admitted to the special-care nursery?
*
Yes
No
If your child already attending a child-care facility, please state the name of this facility.
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, 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
If yes, please provide further detail.
Identity
Do you have any concerns with how your child behaves?
*
Yes
No
If yes, please provide further detail.
Is your child looking forward to starting ELC?
*
Yes
No
Please provide further detail.
Does your child have any fears?
*
Yes
No
If yes, please provide further detail.
Do you have any concerns about how your child gets along with others?
*
Yes
No
If yes, please provide further detail.
Learning
Do you have any concerns about your child's concentration skills?
*
Yes
No
If yes, please provide further detail.
Do you have any concerns about your child follows requests or instructions?
*
Yes
No
If yes, please provide further detail.
Do you have any concerns about your child is learning to do things for themselves?
*
Yes
No
If yes, please provide further detail.
Can your child remember and follow simple routines?
*
Yes
No
If no, please provide further detail.
Can your child answer simple questions? (eg. What is your name?)
*
Yes
No
If no, please provide further detail.
Why did you choose Ballarat Clarendon College for your child's future education?
*
Please include any other information that will help support your child in their transition to ELC.
Permission to contact previous Kindergarten (if applicable)?
*
Yes
No
N/A
Comments
This field is for validation purposes and should be left unchanged.