St Augustine's Kindergarten Application Form - Standalone Kinder (with deferral)

Pre-school Program Application Form

St Augustine's Kindergarten
Internal Application Form

St Augustine's Kindergarten
Child's Name*

First NameLast Name
Gender*

MaleFemaleUnspecified
Child's Date of Birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState

Post Code
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Address

Same as childDifferent address
Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number*
Email*
Please Note: You will be notified of all correspondence via email
Would you like to add a second parent / guardian?*

YesNo
Parent / Guardian 2*

First NameLast Name
Relationship to the child*
Address*

Same as childDifferent address
Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number*
Email*
Please Note: You will be notified of all correspondence via email
Language/s spoken at home:
Service Preference
What year would you like your child to commence? *
What program type is this application relevant to? *
Do you have children that have previously attended St Augustine's Kindergarten?*

YesNo
Names of your other children that have attended St Augustine's Kindergarten
Is or has this child been known to Child Protection (with DFFH services)?*

YesNo
Does this child live in Out-of-Home Care (OoHC)*

YesNo
Map OoHC

Out of home care arrangement (including kinship care)
Does this child have a sibling who has previously attended this Kindergarten?

YesNo
Enrolment & Immunisations
The Government’s No Jab No Play laws require all children to be age-appropriately immunised before enrolment can be confirmed. Further information on immunisation requirements for enrolment in early childhood services is available on the State Government's Better Health Channel at www.betterhealth.vic.gov.au/campaigns/no-jab-no-play
Are your child's immunisation up to date?*

YesNo
Kinder Fee Subsidy
Please indicate if you are eligible for one of the following concessions, or meet one of the following criteria:

Health Care CardPensioner Concession CardDepartment of Veterans Affairs (DVA) Gold Card or White CardRefugee visa (subclass 200)In-country Special Humanitarian visa (subclass 201)Global Special Humanitarian visa (subclass 202)Temporary Humanitarian Concern visa (subclass 786)Protection visa (subclass 866)Emergency Rescue visa (subclass 203)Woman at risk visa (subclass 204)Bridging visa A-E for humanitarian or refugee visaHumanitarian Stay visa (subclass 449)Temporary Protection visa (subclass 785)Safe Haven Enterprise visa (subclass 790)Triplets or QuadrupletsAboriginal or Torres Strait Islander
Health Care card number*
Health care card expiry date*

DayMonthYear
Date
Pensioner card number*
Pensioner card expiry date*

DayMonthYear
Date
Supporting documentation will need to be sighted on commencement at St Augustine's Kindergarten by the Enrolments Officer.

Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found at: https://www.education.vic.gov.au/parents/child-care-kindergarten/Pages/how-much-kindergarten-cost.aspx
Children with Additional Needs
Does your child have any additional needs*

YesNo
If yes, please specify:*
You are encouraged to discuss your child's needs with the educator when your child's place is confirmed.
Is your child registered with a specific Support service / agency?*

YesNo
Name of support service / agency:
Waitlist Fee

A non refundable waitlist fee is payable for all applications. Should you be unable to pay, please contact the Enrolment Officer at: st.augustines.anglican.kin@kindergarten.vic.gov.au to arrange an alternate payment method.
Please confirm your child's application at St Augustine's Kindergarten by paying the $25 waitlist fee via direct funds transfer (details below) and then submitting this form.
BSB: 063109

Account Number: 00921907

Account Name: St Augustines Kindergarten

Payee Description: Child’s name
EFT Reference*
Date Paid*

DayMonthYear
Date
Already Paid?

Yes
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Payment Name
Amount
Payment Type
Payment Reference Number
Form Name
Supress Notifications

YesNo
Do you work or live in the City of Whitehorse?

YesNo
Should be Empty:

Pre-school Program Application Form

Internal Application Form

Enrolment & Immunisations

Kinder Fee Subsidy

Children with Additional Needs

Waitlist Fee