APPLICATION FORM Enrolling for * 2023 2024 2025 2026 2027 Beyond I wish my child to attend (select one answer): 3/4 year old preschool 4/5 year old preschool Both Please select your preferred preschool first then your second, and third preferences in order form the drop down lists. We will always offer first choice places if possible. Where vacancies do not exist, a place at the next closest centre may be offered. * Location 1st Preference - Select One Belgrave Preschool Chirnside Park Preschool Colchester Park Coldstream Preschool Fernhill Preschool Hansen Park Joy Avenue Preschool Lancaster Preschool Launching Place Preschool MECEC Mooroolbark Preschool Millgrove Preschool Montrose Preschool Mount Dandenong Preschool Mount Evelyn Memorial Preschool Sarah Court Sassafras Selby Preschool Upwey Upwey South Wandin Preschool Warburton Preschool Woori Yallock Preschool Location 2nd Preference - Select One Belgrave Preschool Chirnside Park Preschool Colchester Park Coldstream Preschool Fernhill Preschool Hansen park Joy Avenue Preschool Lancaster Preschool Launching Pace Preschool MECEC Mooroolbark Preschool Millgrove Preschool Montrose Preschool Mount Dandenong Preschool Mount Evelyn Memorial Preschool Sarah Court Sassafras Selby Preschool Upwey Upwey South Wandin Preschool Warburton Preschool Woori Yallock Preschool Location 3rd Preference - Select One Belgrave Preschool Chirnside Preschool Colchester Preschool Coldstream Preschool Fernhill Preschool Hansen Park Joy Avenue Preschool Lancaster Preschool Launching Place Preschool MECEC Mooroolbark Preschool Millgrove Preschool Montrose Preschool Mount Dandenong Preschool Mount Evelyn Memorial Preschool Sarah Court Sassafras Selby Preschool Upwey Upwey South Wandin Preschool Warburton Preschool Woori Yallock Preschool CHILD'S DETAILS Child's Legal Name * First Name Last Name Name Child is called eg. abbreviation or nickname Child's Country of Birth * Child's Gender * Male Female Other Child's Date of Birth * ie. DD/MM/YYYY Has your child previously attended a 3 year old Kindergarten? * Yes No If attended a 3 year old kindergarten, when and where? Has your child previously attended a 4 year old Kindergarten? * Yes No If attended a 4 year old kindergarten, when and where? Have you had a previous child at one of our kinders? * Yes No If yes, what was child's full name and kinder they attended? ENROLLING PARENT/GUARDIAN DETAILS Are you a Single Parent/Guardian? * Yes No Parent 1/ Guardian Name * First Name Last Name Parent 1 / Guardian Relationship to the child * Parent 1 / Guardian Contact Phone * Parent 1 / Guardian Email * Parent 1 / Guardian Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent 1 / Guardian Postal Address If different to the previous Address 1 Address 2 City State/Province Zip/Postal Code Country Parent 1 / Guardian were you born in Australia? * Yes No If no, where was Parent 1 / Guardian 1 born? Parent 2 / Guardian Name First Name Last Name Parent 2 / Guardian Relationship to the child Parent 2 / Guardian Contact Phone Parent 2 / Guardian Email Parent 2 / Guardian Home Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parent 2 / Guardian Postal Address If different to the previous Address 1 Address 2 City State/Province Zip/Postal Code Country Parent 2 / Guardian were you born in Australia? Yes No If no, where was Parent 2 / Guardian born? Main language spoken at home If not english If not English, is an interpreter required? Yes No IMMUNISATION As per “No Jab No Play” regulations, children must be fully immunised or hold an authorised medical exemption before enrolment can be confirmed. Maternal and Child Health books are no longer acceptable proof of immunisation status. My child is up to date with his/her childhood vaccinations (please choose 1 option): * Please note that Maternal Child & Health book pages are no longer considered acceptable proof of Immunisation Status. YES - Immunisation History Statement from Australian Immunisation Register attached below. NO - Evidence of commencement of an authorised catch-up program attached below Please Attach HERE Immunisation History Statement from Australian Immunisation Register OR Evidence of commencement of an authorised catch-up program 5MB file size limit - no more than 5 attachments * FileField; MaxSize=5000KB; Multiple; addText=Upload_Your_Files ADDITIONAL DETAILS Is this child/family of Aboriginal/Torres Strait Islander descent? * Yes No Is the child/family from a Refugee or Asylum Seeker background? * Yes No Is this child/family known to Child First, Child Protection or Integrated Family Services? * Yes No Including in Out-of-Home or Kinship Care? * Yes No Has this child previously received Early Start Kindergarten ESK or Access to Early Learning AEL funding? * Yes No Has this child been diagnosed as at risk of anaphylaxis? * Yes No Does this child have a developmental delay, medical condition or disability? * Yes No If yes, please explain CONCESSION CARD HOLDERS Does the child individually or parent/guardian hold a valid concession card * YES - Copy Attached Below No This includes Health Care Card, Pension Card, and Veteran Affairs Card, Asylum Seeker or Refugee Visa. Please attach Copy of Eligible Health Care OR Pensioner Concession Card OR Special Entry Visa (optional) FileField; MaxSize=3000KB; Multiple; addText=Upload_Your_Files PAYMENT DETAILS ($35 Application fee applies) Payment via Credit Card or Electronic Funds Transfer (EFT)? Payment via Credit Card Payment via EFT Credit Card DetailsName on Card Credit Card Number Expiry Date CVC Number 3-digit code on back of Credit Card EFT Details BSB: 633-000 Account Number: 1464 21953 Account Name: Yarra Ranges Kindergartens Inc. Reference: Child’s Name Attending EFT Reference if paying by Electronic Funds Transfer PARENTAL EDUCATION AND OCCUPATION DETAILS The following information is used by the Department of Education and Training to assist in the allocation of funds towards school readiness programs and additional support for children. This information helps the department to decide how much additional funding each kindergarten should receive. It is compulsory for you to complete this information. All responses are treated anonymously. ADULT A PRIMARY CARER EDUCATION * What is the highest year of primary or secondary school the parent/guardian has completed? Year 9 equivalent or below Year 10 or equivalent Year 11 or equivalent Year 12 or equivalent What is the level of the highest qualification the parent/guardian has completed? No non-school certificate Certificate 1-4 (including trade certificate) Advanced diploma/diploma Bachelor degree or above OCCUPATION What is the occupation GROUP of the parent/guardian? Please select the appropriate group from the list below (A, B, C or D). If the person has NOT been in paid work for the last 12 months, select N. If the person is not currently in paid work but has had a job in the last 12 months, please use their last occupation. What is the occupation GROUP of the parent/guardian? A B C D N ADULT B PRIMARY CARER EDUCATION What is the highest year of primary or secondary school the parent/guardian has completed? Year 9 equivalent or below Year 10 or equivalent Year 12 or equivalent Year 12 or equivalent * What is the level of the highest qualification the parent/guardian has completed? No non-school certificate Certificate 1-4 (including trade certificate) Advanced diploma / diploma Bachelor degree or above OCCUPATION * What is the occupation GROUP of the parent/guardian? Please select the appropriate group from the list below (A, B, C or D). If the person has NOT been in paid work for the last 12 months, select N. If the person is not currently in paid work but has had a job in the last 12 months, please use their last occupation. What is the occupation GROUP of the parent/guardian? A B C D N DECLARATION * As the Parent/Guardian* named above, I am authorised to apply to enrol this child and do so in accordance with the official policies of Yarra Ranges Kindergartens Inc. This information provided is true and correct. I understand that no guarantee is given when applying for a place at a preschool. OCCUPATION CATEGORIES
