Mitchell Shire Council - Application Form

Kindergarten Central Registration
Application and offer dates:
- Round 1 kindergarten places close on 1 June
  Offers sent by the end of June
- Round 2 kindergarten places close on 1 July
  Offers sent by the end of July
- Round 3 kindergarten places close on 1 August
  Offers sent by the end of August
All applications received after 1 September will be processed as received.

If you require assistance completing this form please either email admin.childserv@mitchellshire.vic.gov.au or phone (03) 5734 6200

For further information please visit https://www.mitchellshire.vic.gov.au/community/children-and-families/kindergartens
Deferral Form

Yes
input_year
Family Details
Child's Name*

First NameLast Name
Gender*

MaleFemaleOther
Child's Date of Birth*

DayMonthYear
Please attach a copy of your child's birth certificate*

If you don't have a copy of your child's birth certificate or are having trouble attaching a copy, please phone (03) 5734 6200 for assistance.
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Parent / Guardian 1*

First NameLast Name
Parent / Guardian 1 Gender

MaleFemaleOther
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
What country was parent / guardian 1 born in?*
What year did parent / guardian 1 move to Australia?*
Would you like to add a second parent / guardian?*

YesNo
Parent / Guardian 2*

First NameLast Name
Parent / Guardian 2 Gender

MaleFemaleOther
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*
Please Note: You will be notified of all correspondence via email
What country was parent / guardian 2 born in?*
What year did parent / guardian 2 move to Australia?*
Is this child from a multiple birth?
Language/s spoken at home:
Do you require an interpreter?*

YesNo
What is you child's living situation?*

Both ParentsParent / Guardian 1Parent / Guardian 2Formal Kinship CareFoster CarePermanent CareResidential CareInformal Kinship Care
Kindergarten Preferences
What year would you like your child to start kindergarten?*
Please choose a program*
Preference One*
preference_one
Preference Two*
preference_two
Preference Three
preference_three
PLEASE SELECT A UNIQUE OPTION FOR EACH PREFERENCE
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.
Priority Questions
Has this child received a funded 4YO kindergarten place before?*

YesNo
Please provide the Name of the Service and a contact phone number.*

0/245
Additional Information About Your Child
Priority of access - Victorian Government Department of Education

The following information will be used to apply the Victorian Government Department of Education priority of access criteria, and if eligible provide your child priority placement into kindergarten.
Please indicate if:*

The child or family is known to child protection, or has been referred by family support services, or is in out-of-home care (foster or formal kinship care)The child is of Aboriginal or Torres Strait Islander originThe child is a triplet or quadrupletNONE OF THE ABOVE ARE APPLICABLE
ATSI Output
Triplet Output
Please indicate if the child or family is an asylum seeker or refugee by selecting one of the relevant Visas below:*

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 ImmiCardNONE OF THE ABOVE APPLICABLE
Please indicate if the child or parent holds a Commonwealth Concession Card by selecting one of the following concession cards*

Commonwealth Health Care CardChild Disability Health Care CardCommonwealth Pensioner Concession CardDepartment of Veterans Affairs (DVA) Gold Card or White CardNONE OF THE ABOVE ARE APPLICABLE
Concession Calculator
HCC Expiry Date*

DayMonthYear
Date
PCC Expiry Date*

DayMonthYear
Date
Concessions:

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
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 child or family known to child protection? (Children at risk of abuse or neglect including children in Out-of-Home Care)*

YesNo
Does your child have any development, physical, or additional needs?*

YesNo
Please specify additional needs*
Please upload any supporting documents relating to your child's additional needs

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Is your child registered with a specific Support service / agency?*

YesNo
Name of support service / agency:*
Are there any court orders/access arrangements relating to your child?

YesNo
Please upload any supporting documents relating to *

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Does your child have any allergies or medical needs?*

YesNo
Please specify allergies/medical needs*
Please upload any supporting documents relating to your child's allergies/medical needs

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Is your child's immunisation history up to date?*

YesNo
Please upload any supporting documents relating to your child's immunisation history

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Please supply any additional information to support your answer *
Is this child registered with NDIS*

YesNo
Please upload a copy of the NDIS plan

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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 Council 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
Collection Notice

Personal information collected by Council is used for municipal purposes as specified in the Local Government Act, 2020 or other relevant legislation. Council is collecting your personal information so we can contact you regarding your kindergarten application. Your child’s information will be used to support the delivery of Kindergarten Services. Council may disclose this information to other organisations, if required by legislation.

The collection and handling of personal information is conducted in accordance with Council’s Privacy Policy. Please refer to Council's Privacy Statement and Privacy Policy on our website for further information about your rights.
Registration Fee

A non refundable registration fee is payable for all applications.
Already Paid?

Yes

Captcha Verification*
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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Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Kindergarten Central Registration

Family Details

Kindergarten Preferences

Priority Questions

Additional Information About Your Child

Authorisation and Declaration

Registration Fee