Have you got any concerns about your child’s development in regard to speech, physical, emotional, social, behaviour, diet, toilet training?

Is your child undergoing assessment for any of the listed common conditions?

Example: Allergy, Asthma, Behavioural issues, Speech/language delays, Attention Deficit Disorder (ADD or ADHD), Autism Spectrum Disorder, Asperger’s, Diabetes, Epilepsy, other (please specify).

Has your child been diagnosed with any of the above?

Has your child attended Childcare or Family Day Care or other?*

Kindergarten families only – Do you hold current Health Care Card?

Are these days flexible?*

Have you got any concerns about your child’s development in regard to speech, physical, emotional, social, behaviour, diet, toilet training?

Is your child undergoing assessment for any of the listed common conditions?

Example: Allergy, Asthma, Behavioural issues, Speech/language delays, Attention Deficit Disorder (ADD or ADHD), Autism Spectrum Disorder, Asperger’s, Diabetes, Epilepsy, other (please specify).

Has your child been diagnosed with any of the above?

Has your child attended Childcare or Family Day Care or other?*

Kindergarten families only – Do you hold current Health Care Card?

This field is for validation purposes and should be left unchanged.

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Child #2

CAMP FLAT ROAD CENTRE

PARKLAKES DRIVE CENTRE