Bethany Kindergarten Application Form

Deferral Form

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Thank you for choosing a BKS kindergarten for the care and education of your child. BKS kindergartens offer 3 and 4 year old kindergarten programs.

Please note, this is a registration form only. It is not confirmation of a kindergarten place.

A non-refundable fee of $35 is required with each registration. There is no charge for families who are eligible for free kindergarten.

Free kindergarten is provided for children who:

are Aboriginal and/or Torres Strait Islander, or
hold or has a parent/guardian who holds a Commonwealth Health Care Card, Pensioner Concession Card, Veteran’s Affairs Card, or
are a multiple birth child (triplets or more), or
holds or has a parent/guardian who holds a Humanitarian or Refugee Visa

For further information please speak to the enrolments team by phoning 5273 0200.

What year would you like your child to commence kindergarten? *

What program type is this application relevant to? *

Preference One *

Preference Two

Preference Three

Note: Three and four-year-old kindergarten places are allocated separately. We will contact you towards the end of {service-preferences_care-period} to ask you to indicate if {child_Name} will be attending kindergarten in the following year. We will make every effort to place your child at the same service for four-year-old kindergarten. Unfortunately, we aren’t able to guarantee this.

Child's Name *

First Name Last Name

Gender *

Male Female Other

Child's Date of Birth *

Parent / Guardian 1 *

First Name Last Name

Phone Number *

Mobile preferred

Email *

Confirmation Email Please Note: all correspondence will be via this email address

Would you like to add a second parent / guardian? *

Yes No

Parent / Guardian 2 *

First Name Last Name

Phone Number *

Mobile preferred

Email *

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

This information will help us support your family and allocate kindergarten places.

The state government provides free kindergarten 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 / White 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

Health Care Number *

Health Care expiry date *

Pensioner Number *

Pension Card Expiry Date *

Please attach a copy of your concession / visa *

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Max 10MB total file size

Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found here.

The child’s living arrangements are best described as:

Formal Kinship Care Foster Care Permanent Care Informal Kinship Care Care of Parent/s

Are you applying for a second year of kindergarten for your child as recommended by their teacher and approved by the Department of Education and Training? *

Yes No

Does your child have any additional needs *

Yes No

If yes, please specify *

max 255 characters

Please upload any supporting documentation in relation to your child's additional needs

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Is your child registered with a specific Support service / agency? *

Yes No

Name of support service / agency

max 255 characters

Please provide details of your case workers name and contact details

max 255 characters

Is this child or family known to child protection or being supported by Family Support Services?

Yes No

Has your child or an older sibling attended the service of your first preference in the last 5 years? *

Yes No

Child/Sibling Name *

eg. Billie Smith

Year *

Child/Sibling Name

eg. Billie Smith

Year

Sibling Details

Please comment below if you have any additional comments about your child's registration

By submitting this application the parent/guardian agrees and understands:

I declare that all of the information provided on this registration form is true and correct.
This is a registration form, not a guarantee of placement. Offers for kindergarten places will be made in July prior to the application year.

PRIVACY STATEMENT & AGREEMENT

BKS is collecting this information to comply with the Education and Care Services National Law Act 2010 and Education and Care Services Regulation 2011 and also for the purposes of enrolling your child in the BKS Central Enrolment System. BKS considers it necessary and important to collect this information to ensure that appropriate information is registered for your child. This information will be used for BKS administrative purposes and will be provided to relevant kindergarten staff as required for the enrolment of your child at the kindergarten listed on this form. This information will not be disclosed to any other party except as required by law. You may access this information by contacting BKS on 03 5273 0200.

If you have already registered your child to attend a 3 year old program at BKS kindergarten you do not need to pay an additional registration fee to register for kindergarten in the following year.
Please tick if applicable:

Non Refundable Kindergarten Registration Fee

Payment of a non-refundable fee of $35 is required with each registration. Please click pay now to complete payment.

Bethany Kindergarten Services Registration Fee $ 35.00 AUD

Non refundable registration fee

Total $ 0.00 AUD

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

Already Paid?

Yes

form_name

Surpress Notifications

Payment Name

Amount

Payment Type

Payment Reference Number

Program Type

Bethany Kindergarten Services

Kindergarten Preferences

Child's Details

Parent's Details

Additional information about your child

Allocation Criteria

Authorisation and Declaration