Application Form
Name: __________________________________
Address: __________________________________
__________________________________
__________________________________
__________________________________
Date of birth: __________________________________
Contact
Mother’s Name: __________________________________
Mother’s contact no : ______________________________
Father’s Name: __________________________________
Father’s contact no: _______________________________
Parent/Guardian Email address: ______________________________
Please nominate two people to collect your child if you are unavailable.
Please include name and mobile numbers:
(1) Name: __________________________________
Contact: __________________________________
(1) Name: __________________________________
Contact: _________________________________
Medical
Family doctor: __________________________________
Contact details: __________________________________
Any known allergies: __________________________________
__________________________________
Are all immunisations up to date: Yes/No
Please specify any special dietary requirements:
______________________________
Other relevant information about your child:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Education
Primary school attending in future:
___________________________________________________________
Has your child previously attended another preschool? If Yes, please give
details
___________________________________________________________
___________________________________________________________
Session Preferences
Morning (9am-12) / Afternoon (12.15-3.15pm) (Please circle)
If part-time please give preferred days:
___________________________________________________________
(Please note: At Blossoms we will make the best effort to accommodate
all preferences but some flexibility may be required)