Gum Nut Gully Preschool - Application Form

Gum Nut Gully Preschool Application Form
If you would like to place your child on the waitlist at Gum Nut Gully Preschool please complete the following form. Please Note: we will accept applications anytime in the year your child turns two.
Deferral Form

Yes
Child's Name*

First NameLast Name
Gender*

MaleFemaleUnspecified
Child's Date of Birth*

DayMonthYear
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

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 kindergarten? *
What program type is this application relevant to? *
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
Eligibility Criteria
Do any of the following concessions, or criteria apply

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 IslanderImmiCard
Supporting documentation will need to be sighted on commencement at Gum Nut Gully 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: https://www.education.vic.gov.au/parents/child-care-kindergarten/Pages/how-much-kindergarten-cost.aspx
Other Information
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:
Does this child have a sibling who has previously attended this kindergarten?*

YesNo
Application Fee
The application fee for our preschool is a non-refundable fee of $50 or $20 for a child who identifies as Aboriginal and/or Torres Strait Islander, or can supply a current copy of a health care card or concession card.

Total Payable: $50.00
BSB: 633000
Account Number: 163519846
Account Name: Gum Nut Gully Preschool Association
Payee Description: Child’s Name
EFT Reference*
Date Paid*

DayMonthYear
Date
Payment Name
Amount
Payment Type
Payment Reference Number
What service is this registration for?
Already Paid?

Yes
Form Name
Should be Empty:

Gum Nut Gully Preschool Application Form

Enrolment & Immunisations

Eligibility Criteria

Other Information

Application Fee