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.
Deferral Form

Yes
input_year
Family Details
Child's Name*

First NameLast Name
Gender*

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
Would you like to add a second parent / guardian?*

YesNo
Parent / Guardian 2*

First NameLast Name
Relationship to the child*
Parent / Guardian 2 Address*

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.
Would you be interested in learning more about the After Kinder Care at The Patch Kindergarten?*

YesNo
Would you be interested in learning more about the Nature Play Sessions at Kallista Kindergarten?*

YesNo
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
Please indicate if you are eligible for one of the following concessions, or meet one of the following criteria:

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 IslanderCurrent or expired ImmiCard
Health Care Number*
Health Care expiry date*

DayMonthYear
Pensioner Number*
Pension Card Expiry Date*

DayMonthYear
Please attach a copy of your concession / visa*

Browse Files
Max 10MB total file size Cancelof
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
Is this registration for a child with a disability that is intellectual, sensory or physical?*

YesNo
If yes, please specify:*
Is your child registered with a specific Support service / agency?*

YesNo
Name of support service / agency:
Is this child or family known to child protection?*

YesNo
Are there any court orders relating to the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child?*

YesNo
Has this child received a funded 4YO kindergarten place before?*

YesNo
Has your child or an older sibling attended the service of your first preference in the last 3 years?*

YesNo
How did you hear about us?*

FacebookWord Of MouthInternet SearchPreviously AttendedLetterbox DropOther
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
Already Paid?

Yes
Payment Name
Amount
Payment Type
Surpress Notifications
Payment Reference Number
Todays Date

DayMonthYear
Date
Cutoff date calculator
Cutoff Date

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

Kindergarten Application Form

Family Details

Kindergarten Preferences

Additional Information About Your Child

Authorisation and Declaration