APPLICATION FOR WAIT LIST
Child's Given Name: *
Child's Given Name:
M/F: *
D.O.B. Please note American format: *
D.O.B. Please note American format:
Address: *
Address:
Care Giver:
1: Care Giver's Name: *
1: Care Giver's Name:
2: Care Giver's Name:
2: Care Giver's Name:
Do you have a Low income Health Care Card *
Is your child of Aboriginal or Torres Strait Island decent? *
Have you had a child previously enrolled at Riverside: *

Please direct deposit your $30 wait list fee to:

Riverside Preschool

BSB: 062-182

ACC: 10058173