Prep enrolment questionnaire – Ballarat Clarendon College

Student surname*

Student given names*

Date of birth*

Parent/Guardian 1 full name*

Parent/Guardian 2 full name

Enrolment year*

Which term will you begin your enrolment with us?*

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

Background Information

Who is in your child's family?*

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

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 an 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?

Where does your child currently attend kindergarten or school?*

Name of current kindergarten or classroom teacher:*

Do you give permission for us to contact the current/previous Kindergarten?*

Yes
No

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 below and provide any reports directly to the Admissions Office.

Identity

Is your child looking forward to starting school?*

Yes
No

Please provide further detail.

Do you have any concerns with how your child behaves?*

Yes
No

If yes, 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

Has your child been assessed for a learning disorder, such as ADHD, ASD, Dyspraxia?*

Yes
No

If yes, please provide further detail and reports, if applicable.

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 following requests or instructions?*

Yes
No

If yes, please provide further detail.

Do you have any concerns about how 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 school.

Phone

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