Application Form - Rangeview Pre school

Gumnuts - Register Your Interest Form

Rangeview Pre-School
Internal Application Form

Rangeview Pre-School
Deferral Form

Yes
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:
What year would you like your child to commence?*
What program type is this application relevant to?*
What program type is this application relevant to? *
Service Preference*
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
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 Rangeview Pre-School 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 Special Needs
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:
Already Paid?

Yes
Payment Name
Amount
Payment Type
Payment Reference Number
Form Name
I understand this is only registration form and does not guarantee an offer for my child to attend Gumnuts pre-kinder program.*

Agreed
Should be Empty:

Gumnuts - Register Your Interest Form

Internal Application Form

Enrolment & Immunisations

Kinder Fee Subsidy

Children with Special Needs