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
Departure time

: hour

minute

AM/PM
TUESDAY: Arrival time

: hour

minute

AM/PM
Departure time

: hour

minute

AM/PM
WENESDAY: Arrival time

: hour

minute

AM/PM
Departure time

: hour

minute

AM/PM
THURSDAY: Arrival time

: hour

minute

AM/PM
Departure time

: hour

minute

AM/PM
FRIDAY: Arrival time

: hour

minute

AM/PM
Departure time

: hour

minute

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

Child's Details