Application Form - Geelong West

If you would like to place your child on the waitlist at Geelong West Kindergarten please complete the following form.

Enrolment applications are now accepted 2 years before your child is eligible to attend our kindergarten.

Please note that your child must turn 3 by the 31st of January in order to attend our Pre-kinder program in that year, or 4 by the 30th of April in order to attend Kindergarten in that year.

At the end you will be asked to pay a non refundable $11 application fee via credit card.

Deferral Form

Yes

Child's Name *

First Name Last Name

Gender *

Male Female Unspecified

Child's Date of Birth *

Address *

Street Address

Street Address Line 2

City State

Post Code

Parent / Guardian 1 *

First Name Last Name

Relationship to the child *

Address

Same as child Different address

Address *

Street Address

Street Address Line 2

City State

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? *

Yes No

Parent / Guardian 2 *

First Name Last Name

Relationship to the child *

Address *

Same as child Different address

Address *

Street Address

Street Address Line 2

City State

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 Geelong West Kindergarten? *

What program type is this application relevant to? *

Do you have children that have previously attended Geelong West Kindergarten? *

Yes No

Names of your other children that have attended Geelong West Kindergarten

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? *

Yes No

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 Card Pensioner Concession Card DVA Gold Card Bridging Visas A – F Temporary Protection/Humanitarian Visas 447, 451, 785 or 786 Resolution of Status Visa (RoS) Visa Class CD, Subclass 851 Refugee and Special Humanitarian Visas 200–217 Triplets or Quadruplets Aboriginal or Torres Strait Islander

Supporting documentation will need to be sighted on commencement at Geelong West 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

Does your child have any special needs *

Yes No

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? *

Yes No

Name of support service / agency:

Geelong West Kindergarten Application Fee $ 11.00 AUD

Total $ 0.00 AUD

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

Already Paid?

Yes

Payment Name

Amount

Payment Type

Payment Reference Number

Form Name

Geelong West Kindergarten Application Form

Enrolment & Immunisations

Kinder Fee Subsidy

Children with Special Needs

Application Fee