Application Form - Yarraleen Preschool

If you would like to place your child on the application at Yarraleen Preschool please complete the following form. Please Note: we will accept applications anytime in the year your child turns two. At the end you will be asked to pay a non-refundable $30 application fee via credit card.

Deferral Form

Yes

Child's Name*

First NameLast Name

Gender*

MaleFemaleOther

Child's Date of Birth*

Address*

Street Address

Street Address Line 2

SuburbState

Post Code

Parent / Guardian 1*

First NameLast Name

Relationship to the child*

Address

Same as childDifferent address

Address*

Street Address

Street Address Line 2

SuburbState

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

SuburbState

Post Code

Phone Number*

Email*

Please Note: You will be notified of all correspondence via email

Language/s spoken at home:

What year would you like your child to commence at Yarraleen Preschool? *

What program type is this application relevant to? *

Are you interested in extended care for your child (18 hour program)?*

Do you have children that have previously attended Yarraleen Preschool?*

YesNo

Names of your other children that have attended Yarraleen Preschool

Do you work or live in the city of [update here]?

YesNo

Does this child have a sibling who has previously attended this Kindergarten?

YesNo

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

DET provides a fee subsidy for eligible families. Please indicate if you are eligible for one of the following concessions, or meet one of the following criteria:

Health Care CardPensioner Concession CardDVA Gold CardBridging Visas A – FTemporary Protection/Humanitarian Visas 447, 451, 785 or 786Resolution of Status Visa (RoS) Visa Class CD, Subclass 851Refugee and Special Humanitarian Visas 200–217Triplets or QuadrupletsAboriginal or Torres Strait Islander

Supporting documentation will need to be sighted on commencement at Yarraleen Preschool by the Enrolments Officer.

Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found at: www.education.vic.gov.au/childhood/parents/support/Pages/financialassist.aspx

Does your child have any special 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:

To submit your application, please pay the non-refundable $30 application fee via credit card below.

Application Fee*

Yarraleen Kindergarten Application Fee$30.00AUD

Total $0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Already Paid?

Yes

Payment Name

Item

Amount

Payment Type

Form Name

child_sessionpreferences

Extended Care

How would you like to pay

EFT Reference Number*

As referenced on your bank transfer

Payment Reference Number

Yarraleen Preschool Application Form

Enrolment & Immunisations

Kinder Fee Subsidy

Children with Special Needs

Application Fee