Butterfield House Kindergarten

Butterfield House Kindergarten Application Form
If you would like to place your child on the waitlist at Butterfield House Kindergarten please complete the following form. Please Note: we will accept applications anytime in the year your child turns two.
Butterfield House have a sister kindergarten, Williams House. Would you like us to share these application details for your child with Williams House kindergarten in the event that our waitlist exceeds places available?

YesNo
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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:
Does this child have a sibling who has previously attended this kindergarten?

YesNo
What year would you like your child to commence kindergarten? *
What program type is this application relevant to? *
Service Preference*
Is your child enrolled in a local primary school?*

YesNo
If yes, please provide the name of the primary school*
Does this child have a parent/guardian that is a current staff member of Butterfield House or Christian College?*

YesNo
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
Kindergarten Fees
Please be aware that Butterfield House does NOT offer Free 3-year-old or 4-year-old Kindergarten Programs, under the Victorian Government Free Kindergarten Scheme. Butterfield House fees are charged termly & paid by families in full via direct debit from their nominated account. Eligible families can access kindergarten Fee Subsidy.
Kinder Fee Subsidy
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 Sample 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
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:
Payment Name
Amount
Payment Type
Payment Reference Number
Already Paid?

Yes
Form Name
Would you like to pause the send of a notification email for this change?*

YesNo
Should be Empty:

Butterfield House Kindergarten Application Form

Enrolment & Immunisations

Kindergarten Fees

Kinder Fee Subsidy

Other Information