Mildura Application and PPF Form

Mildura Rural City Council Kindergarten Registration Form

Please complete this form to register your child for 3 or 4-year-old kindergarten. Once allocations have been completed, your kindergarten will be in touch regarding enrolment.
Child Details
Child's Name*

First NameLast Name
Gender*

MaleFemaleUnspecified
Child's Date of Birth*

DayMonthYear
Child's Address*

Street Address

Street Address Line 2

CityState

Post Code
Immunisation

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

Please note: we do not ask you attach the immunisation history statement at this time. You will be required to provide an up to date immunisation history statement at a later date as part of the kindergarten enrolment confirmation.
Are your child's immunisation up to date?*

YesNo
Due to the State Government policy No Jab No Play your child may not secure an enrolment place in a funded Kindergarten program if proof of immunisation cannot be provided.
Has your child had their 3.5 year old Maternal & Child Health check?*

YesNo
Would you like to be contacted about making this appointment?*

YesNo
Is your child Eligible for Early Start Kindergarten?
For information regarding Early Start Kindergarten: Early Start Kindergarten | Victorian Government (www.vic.gov.au)
Is your family from a refuge or asylum seeker background?*

YesNo
Does your child identify as Aboriginal and/or Torres Strait Islander?*

YesNo
Has your child or family had contact with child protection or connected with the Department of Families, Fairness and Housing or any other support services (eg Orange Door)?*

YesNo
Parent Details
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Is Parent / Guardian 1's postal address different to the child's address provided

YesNo
Parent / Guardian 1 Postal Address*

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*
Is Parent / Guardian 2's postal address different to the child's address provided

YesNo
Parent / Guardian 2 Postal 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 an alternate contact?*

YesNo
Alternate Contact Name*

First NameLast Name
Alternate Contact Relationship to Child*
Alternate Contact Phone Number*
Language/s other than English spoken at home:
Is an interpreter required?*

YesNo
How will your child get to Kindergarten?*

Own CarFamily member or friendPublic TransportWalkUnreliable transportOther
Kindergarten Preferences

You can choose all 3 preferences at one service or session times at multiple services.
What year would you like your child to commence kindergarten? *
What year would you like your child to commence kindergarten? *
What program type is this application relevant to?*
Please Note: 4 Year Old Kindergarten can be selected for children who are eligible for Early Start Kindergarten
Care Period Mapped
PPPC Input
P1 Eligible
P2 Eligible
Pre Prep Priority Cohort
Kindergarten Session Times
Note that kindergartens are not zoned and you may select a service of your choice
Kinder Fee Subsidy
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:

Commonwealth Health Care CardCommonwealth Pensioner Concession 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)Department of Veterans Affairs (DVA) Gold Card or White CardTriplets or QuadrupletsAboriginal or Torres Strait IslanderCurrent or expired ImmiCard
Supporting documentation will need to be sighted on commencement at Kindergarten.

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

Mildura Rural City Council Kindergarten Registration Form

Child Details

Is your child Eligible for Early Start Kindergarten?

Parent Details

Kindergarten Preferences

Kindergarten Session Times

Kinder Fee Subsidy

3 Year Old Kindergarten

4 Year Old Kindergarten

3 Year Old Kindergarten - Preferences

4 Year Old Kindergartens - Preferences

Additional Information