Burch Memorial Preschool - Application Form

Burch Memorial Preschool Application Form
If you would like to place your child on the waitlist at Burch Memorial Preschool please complete the following form.
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:
To enrol in a Burch Memorial Preschool program, children must:
- Turn 3 years of age on or before 30th April in the year they attend 3yo kindergarten, or
- Turn 4 years of age on or before 30th April in the year they attend 4yo kindergarten.
A child whose 3rd birthday is between January – April is eligible to defer their attendance in 3yo kindergarten, or enrol for the following year. All children in 3yo Kindergarten will be expected to transition to 4yo Kindergarten in the following year. A funded second year of kindergarten will only be available for children in the 4yo Kindergarten program who meet the criteria.
What year would you like your child to commence kindergarten? *
What program type is this application relevant to? *
Preference One*
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
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:
Does this child have a sibling who has previously attended this kindergarten?*

YesNo
Please provide the name(s) of these siblings and their years of attendance.

0/250
In the year of kindergarten attendance, does this child have an older sibling who will be enrolled at Wonga Park Primary School?

YesNo
Do you intend for your child to attend Wonga Park Primary School in their Prep (Foundation) year?

YesNo
Payment Name
Amount
Payment Type
Payment Reference Number
Already Paid?

Yes
Form Name
Should be Empty:

Burch Memorial Preschool Application Form

Enrolment & Immunisations

Kinder Fee Subsidy

Other Information