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Date of Birth? position in the family What is your sex? Previous nursery/school attended

State of Origin? Nationality Home Address Parent/Guardian’s Name Parent/Guardian’s Tel phone Parent/Guardian’s Email

Home Language(s) Religion Does your child have specific Special Educational Needs? if yes, why? Does your child have any physical disability(s)? if yes Kindly give a brief description Are there specific Medical Challenges? If Yes, indicate what the challenge is

Does your child suffer from any allergies ? if yes, please give clear details i.e. Peanuts, Plasters,

Does your child have Speech Therapy? Yes/no Or ever been referred to a Speech Therapist?

Parental Responsibility