Northern Schools Early Years (NSEY)- 2 Step Application Form

Northern Schools Early Years Application Form
Northern Schools Early Years Application Form for Rothschild Road Kindergarten @ Willowbank Primary School

The Victorian Government provides funding to kindergarten and long day care services. Northern Schools Early Years Cluster is committed to high-quality early years education and support to families at no cost. Kinder is Free.
Northern Schools Early Years Application Form for Molesworth Street Kindergarten @ North Melbourne Primary School

The Victorian Government provides funding to kindergarten and long day care services. Northern Schools Early Years Cluster is committed to high-quality early years education and support to families at no cost. Kinder is Free.
Child's Name*

First NameLast Name
Child's Date of Birth*

DayMonthYear
Birth Certificate*

Browse Files

Cancelof
Gender*

MaleFemaleUnspecified
Language/s spoken at home:*
Parent / Guardian 1*

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

Same as parent / guardian 1Different to parent / guardian 1
Address*

Street Address

Street Address Line 2

CityState

Post Code
Phone Number*
Email*
Please Note: You will be notified of all correspondence via email
Kindergarten Preferences
What year would you like your child to commence care? *
What program type is this application relevant to?*
Kindergarten*
Do you have children who are current attending North Melbourne Primary School?*

YesNo
Do you have children who are current attending Willowbank Primary School?*

YesNo
Mapped - children who are currently attending connected primary school*

YesNo
Do you have children that have previously attended {servicepreferences_preference1}?*

YesNo
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 Data Collection
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: www.education.vic.gov.au/childhood/parents/support/Pages/financialassist.aspx
Children with Additional Needs
Does your child have any additional 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:*
Declaration
I give permission for this information to be shared with Northern Schools Early Years for the purposes of:
• accessing kindergarten and,
• if applicable, applications for State funding necessary to provide additional support for my child’s participation.

I give permission for this data to be anonymised, de-identified and aggregated (and shared with identified third parties) to help forecast future needs and help to improve the service.

I declare that all of the information provided is true and correct.
Signature*

Clear
Send Notification?*
Payment_type
payment_1_amount
payment_1_name
payment_1_item
form_name
programType
token
Already Paid?

Yes
show_preferences_only

Yes
transfers

Yes
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Yes
Deferral Form

Yes
Should be Empty:

Northern Schools Early Years Application Form

Northern Schools Early Years Application Form for Rothschild Road Kindergarten @ Willowbank Primary School

Northern Schools Early Years Application Form for Molesworth Street Kindergarten @ North Melbourne Primary School

Kindergarten Preferences

Enrolment & Immunisations

Kinder Data Collection

Children with Additional Needs

Declaration