EV Early Years Manager - Application Form

Kindergarten Application Form

EV Early Years Manager
Welcome to EV EYM. This is your first step towards enrolling your little one into one of our kindergartens. Please take the time to review and complete the form.
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Family Details
Child's Name*

First NameLast Name
MaleFemaleUnspecified
Child's Date of Birth*

DayMonthYear
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Parent / Guardian 1 Address*

Street Address

Street Address Line 2

CityState

Post Code
Mobile Number*
Email*
Please Note: You will be notified of all correspondence via email
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Parent / Guardian 2*

First NameLast Name
Relationship to the child*
Same as parent / guardian 1Different to parent / guardian 1
Parent / Guardian 2 Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number*
Email*
Language/s spoken at home:
Kindergarten Preferences
What year would you like your child to commence care? *
Please indicate if your application is for 3 Year Old or 4 Year Old Kindergarten*
Preference One*
Preference 1*
Preference Two*
Preference Three
Please note: Based on the Date of birth you have provided, your child is too young to commence 3 Year Old Kindergarten in the year you have selected. Please contact us if you wish to discuss further.
Please attach confirmation of your address (eg. rates notice or a bill) *

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Additional Information About Your Child
By completing the following information, you will help our team support your family. This information will also be used to access priority of access for a kindergarten placement
Refugee 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)Current or expired ImmiCard
Please attach a copy of your concession / visa*

Max 10MB total file size
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Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found at: https://www.vic.gov.au/kindergarten
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Health Care Number*
Health Care expiry date*

DayMonthYear
Please attach a copy of the Health Care card*

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Pensioner Number*
Pension Card Expiry Date*

DayMonthYear
Please attach a copy of your Pensioner Concession card*

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Please attach a copy of your Department of Veterans Affairs card*

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NoTorres Strait IslanderAboriginalBoth Aboriginal and Torres Strait Islander
YesNo
YesNo
If yes, please specify:*
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Name of support service / agency:
YesNo
YesNo
Second Year of Funded Kindergarten
Children enrolled in a funded kindergarten program are eligible to access a repeat year of funded 3 or 4 year old kindergarten, only if the early childhood teacher has assessed eligibility for your child to be considered for a second year.
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3YO4YO
3YO4YO
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Authorisation and Declaration
By submitting this registration form, I understand and agree to the following:
- All information provided by me is true and correct
- All information provided by me may be audited at any time. This registration or subsequent kindergarten allocation could be reallocated or withdrawn if the information is incorrect
- Failure to provide complete and correct information may result in the registration being excluded from the allocation process
- This is a registration form and does not guarantee a three or four-year-old kindergarten placement
- Three and four-year-old kindergarten places are allocated separately. Every effort will be made to place my child at the same service for four-year-old kindergarten. However, there is no guarantee of this.
- I can be contacted by EV EYM from time to time with information regarding relevant events, issues and services
- To participate in the Central Registration Scheme my personal information will be shared securely with the preferred kindergarten service provider nominated by me on this or subsequent forms
Data Collection and Privacy
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Payment Name
Amount
Payment Type
Surpress Notifications
Payment Reference Number
Todays Date

DayMonthYear
Date
Cutoff date calculator
Cutoff Date

DayMonthYear
Date
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Age as at cutoff
ineligible to apply
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Should be Empty:

Kindergarten Application Form

Family Details

Kindergarten Preferences

Additional Information About Your Child

Authorisation and Declaration