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Waitlist Form
Queenstown Preschool and Nursery
Child's Details
CHILD'S NAME
*
First
Last
SEX
Male
Female
DATE OF BIRTH
*
DD slash MM slash YYYY
WHICH CENTRE WOULD YOU LIKE YOUR CHILD ENROLLED IN?
*
Nursery
Preschool
Parent / Guardian Contacts
PARENT GUARDIAN
*
First
Last
HOME ADDRESS
*
Street Address
City
EMAIL
*
MOBILE PHONE
*
HOME PHONE
Attendance Details
What date would you like your child to start?
*
DD slash MM slash YYYY
MONDAY: Arrival time
:
hour
minute
AM
PM
AM/PM
Departure time
:
hour
minute
AM
PM
AM/PM
TUESDAY: Arrival time
:
hour
minute
AM
PM
AM/PM
Departure time
:
hour
minute
AM
PM
AM/PM
WENESDAY: Arrival time
:
hour
minute
AM
PM
AM/PM
Departure time
:
hour
minute
AM
PM
AM/PM
THURSDAY: Arrival time
:
hour
minute
AM
PM
AM/PM
Departure time
:
hour
minute
AM
PM
AM/PM
FRIDAY: Arrival time
:
hour
minute
AM
PM
AM/PM
Departure time
:
hour
minute
AM
PM
AM/PM
CONSENT
• I will notify QPN if I no longer require my child’s name on the Waiting List.
• I will contact QPN monthly to confirm I would like to remain on the Waiting List.
• I understand that if I do not contact the QPN monthly my child’s name will be taken off the List
Parent / Guardian Name:
*
Date
*
MM slash DD slash YYYY
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