Kootingal & District Preschool

Kootingal & District Preschool

Waitlist Form
Deferral Form

Yes
Program Type
Child's Name*

First nameLast name
Gender*

MaleFemaleOther
Child's date of birth*

DayMonthYear
Parent / Guardian 1*

First nameLast name
Phone Number*
Email*
Please note: you will be notified of all correspondence via email. This email will be used for all future correspondence unless otherwise advised.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Attendance Preferences
What year does this registration apply for?*
Will your child be eligible for school in the year following the year selected above?*

YesNo
Would you prefer 2 or 3 days of care?*
Would you prefer 2 or 3 days of care?*
You are eligible for 2 days of care, please indicate all prefered days below
Please note: When selecting your days, a 3rd day allocation is not guaranteed and is subject to availability.
What days of care are you interested in? (please select all that are possible)*

MondayTuesdayWednesdayThursdayFriday
What days of care are you interested in? (please select all that are possible)*

MondayTuesdayWednesdayThursdayFriday
Additional Information
Does your child attend another preschool/long day-care service?*

YesNo
What year will your child start school?*
Does your family hold one of the following concession cards?

Health Care Card (Where the child is named as a dependent)Pensioner Concession Card (Where the child is named as a dependent)Veteran Card
Health Care Number*
Health Care expiry date*

DayMonthYear
Please attach a copy of the Health Care Card*

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Pensioner Concession Card Number*
Pensioner Concession Card expiry date*

DayMonthYear
Please attach a copy of the Pensioner Concession Card*

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Department of Veterans Affairs Number*
Department of Veterans Affairs expiry date*

DayMonthYear
Please attach a copy of the Veterans Card*

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Does this child identify as Aboriginal / Torres Strait Islander?*

NoTorres Strait IslanderAboriginalBoth Aboriginal and Torres Strait Islander
Does your child have any additional needs?*

YesNo
If yes, please specify:*

0/255
Which of the following relevant professionals made the assessment?*
If 'Other', please provide the profession*
Please attach a copy of the assessment or letter*

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Does your child have a NDIS number?*

YesNo
NDIS Number:*
Will your child require additional support in understanding and communicating in English language at preschool?*

YesNo
Language used by your child (other than English):*
Is your child at risk of harm?*

YesNo
Does this child have a sibling who has previously attended this preschool?*

YesNo
Please enter sibling details (First Name, Last Name, Year of Attendance)*
Send Notification?*
Payment Name
Amount
Payment Type
alreadyPaid
form_name
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Program type*
31July in year of commencement
31 July in year of commencement convert to date format

YearMonthDay
Date
Age at 31July starting year
ATSI Output
HCC Output
PCC Output
DVA Output
Concessions Calculator
Concessions

Aboriginal or Torres Strait IslanderBridging visa A-E for humanitarian or refugee visaCommonwealth Health Care CardCommonwealth Pensioner Concession CardCurrent or expired ImmiCardDepartment of Veterans Affairs (DVA) Gold Card or White CardEmergency Rescue visa (subclass 203)Global Special Humanitarian visa (subclass 202)Humanitarian Stay visa (subclass 449)In-country Special Humanitarian visa (subclass 201)Protection visa (subclass 866)Refugee visa (subclass 200)Safe Haven Enterprise visa (subclass 790)Temporary Humanitarian Concern visa (subclass 786)Temporary Protection visa (subclass 785)Triplets or QuadrupletsWoman at risk visa (subclass 204)
EF Item_ [Add Item Number]
payment_payrix
Current Date

YearMonthDay
Date
Copy Attendance Year for calcs
Should be Empty:

Attendance Preferences

Additional Information