Moorabool Shire Council - Registration Form

Moorabool Shire Council Kindergarten Registration Form
Deferral Form

Yes
Child's Name*

First NameLast Name
Gender*

MaleFemaleOther
Child's Date of Birth*

DayMonthYear
Do you or your child identify as Aboriginal or Torres Strait Islander?*

AboriginalTorres Strait IslanderBoth Aboriginal and Torres Strait IslanderNeither Aboriginal or Torres Strait Islander
Mapped - Do you or your child identify as Aboriginal or Torres Strait Islander?*

AboriginalTorres Strait IslanderBoth Aboriginal and Torres Strait IslanderNo not Aboriginal or Torres Strait Islander
Is your child known to Child Protection, Orange Door/Child FIRST or in an Out of Home Care arrangement including kinship care?*

YesNo
Child's Living Arrangement*

Both ParentsSole ParentFormal Kinship CareFoster CarePermanent CareResidential CareInformal Kinship CareOther
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
Mobile Phone Number*
No spaces
Email*

Confirmation EmailPlease Note: You will be notified of all correspondence via email
Does the family require an interpreter?*
Language/s spoken at home:*
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
What year would you like your child to commence kindergarten? *
Mapped Care Period *
What program type is this application relevant to? *
Please note: Based on the Date of birth you have provided, your child is not within the correct age bracket to commence/attend Kindergarten in the year you have selected. Please contact us by the following details if you wish to discuss further.

earlyyears@moorabool.vic.gov.au
0353667100
Additional Information
Do any of the following concessions, or criteria apply

Commonwealth Health Care CardCommonwealth Pensioner Concession CardRefugee visa (subclass 200)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
Health Care Number*
Health Care expiry date*

DayMonthYear
Pensioner Number*
Pension Card Expiry Date*

DayMonthYear
Please upload a copy of your concession documentation

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Are you currently or intending to be a Moorabool resident?*

Yes, I am currently a residentYes, I intend to become a residentNo
Please upload one of the following as your proof of residence.
- Rates Notice
- Driver's Licence
- Utility Bill
Please upload one of the following as your proof of intention to become a resident
- Contract of Sale, Rental Agreement or Certified Statutory Declaration
Please attach proof of residency.*

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Do you have a connection to Moorabool Shire through work, study or childcare arrangements?*

YesNo
Please attach proof of work, study or childcare in Moorabool*

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e.g a Letter from employer or educational institution Cancelof
Is your child registered with a specific Support service / agency?*

YesNo
Name of support service / agency (type)*

CALD Outreach OfficerEnhanced Maternal Child Health NurseNDIS (National Disability Insurance Scheme)Maternal Child Health NurseChild Protection (DFFH) workerSupported Playgroup OfficerEarly Intervention WorkerPreschool Field OfficerOther
Name of support service / agency:
Children with additional needs are defined as:
- Require additional assistance to fully participate in the kindergarten program.
- Require a combination of services which are individually planned.
- Have an identified specific disability or developmental delay
Does your child have any additional needs*

YesNo
Details of additional needs*
max 255 characters
Please indicate if any of these are relevant for you child:
Please upload supporting documentation

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Please contact Early years on earlyyears@moorabool.vic.gov.au if you have any difficulty producing this documentation Cancelof
Kindergarten Preferences

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Please select a unique option for each preference.
Authorisation and Declaration
- I acknowledge and understand that under the No-Jab-No Play legislation, in order to finalise enrolment of my child I will need to supply the kindergarten with evidence that my child is; fully immunised for age or on a vaccination catch up program or unable to be fully immunised for medical reasons.
- I agree to Moorabool Shire Council's Kindergarten Central Registration Policy. Please refer to the Moorabool Shire Council website to access this document.
- I agree to Moorabool Shire Council's privacy policy.
- I, being the Parent/Legal Guardian, confirm my registration for my child’s three-year-old or four-year-old kindergarten register into Moorabool Shire Council’s Central Register System.
Already Paid?

Yes
Program Type
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Yes
Form Name
Send Notification?*
Date

DayMonthYear
Date
Cutoff date calculator
Cutoff Date

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

Moorabool Shire Council Kindergarten Registration Form

Additional Information

Kindergarten Preferences

Authorisation and Declaration