Palm Grove Preschool - Application Form

Palm Grove Preschool Application Form
If you would like to place your child on the waitlist at Palm Grove Preschool please complete the following form. Please Note: we will accept applications anytime in the year your child turns two. At the end you will be asked to pay a non-refundable $20 registration fee via direct funds transfer.
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:*
What year would you like your child to commence kindergarten? *
What program type is this application relevant to? *
Service Preference 1
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
Registration Fee
A $20 refundable registration fee is payable for all applicants. Contact the administration officer when your child has commenced preschool for the refund. Please make payment via a direct funds transfer using the following details:

Total Payable: $20
Account Name: Palm Grove Preschool Centre Inc.
BSB: 633000
Account Number: 173349408
Payee Description: Child’s Name
Payment Reference Number*
Date Paid*

DayMonthYear
Date
Payment Name
Amount
Payment Type
Already Paid?

Yes
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Yes
Form Name
Send Notification?*
Should be Empty:

Palm Grove Preschool Application Form

Enrolment & Immunisations

Kinder Fee Subsidy

Other Information

Registration Fee