The Jack & Jill Kindergarten Hornsby - NSW

The Jack & Jill Kindergarten (Hornsby)

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
Parent / Guardian 1 Preferred Name
Relationship*
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 Preference
Year requested for placement*
If your child does not get a place this year, they will be kept on the waiting list for the following year if eligible.

Program Approach

Preference 1*
Preference 2*
Preference 3*

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Priority of Access
The NSW State Government requires us to fill our preschool places according to priorities listed below:
- children who are at least 4 years old on or before the 31 July in that preschool year and not enrolled or registered at a school
- children who are at least 3 years old on or before 31 July in that preschool year and are:
  - children from low income families
  - children with an Aboriginal and Torres Strait Islander background
  - children with disability or additional needs.
- children who are at least 3 years old on or before 31 July in that preschool year with English language needs.
- children who are at risk of significant harm (from a child protection perspective).
Age-based priority will be calculated based on your child’s date of birth.
Please provide as much information as possible about other priority of access criteria met by your child or your family below.
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 a disability or any additional needs?*

YesNo
Please note: The Jack & Jill Kindergarten runs an Inclusion Support Program with an Inclusion Support Teacher supporting these children. However, please understand that placements are limited and due consideration will need to be made regarding whole group dynamics in relation to the number of children with significant disabilities or learning difficulties attending, so that resources and other factors are manageable without disadvantaging the child, others already accessing the service, and staff.
If yes, please specify:*

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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:*
Do you have any concerns about your child’s development?*

YesNo
Please briefly explain your concerns:*

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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
Is there any other information / detail you would like to let us know?

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Returning Families
Returning families may be prioritised after the above NSW Government priorities are met.
Does this child have a sibling who has previously attended this preschool?*

YesNo
Please enter sibling details (First Name, Last Name, Year of Attendance)*
Additional Information
Does your child currently attend another centre?*

YesNo
Please provide centre name/s:*
How did you hear about us?*

Referred by a health professionalFrom friendsWalking pastFrom yellow advertisementOther
Submission Declaration
I understand it is a condition of enrolment at The Jack & Jill Kindergarten that my child will not be enrolled at another community-based preschool* at the same time, and that enrolment will be terminated if this policy is breached. Please understand that this policy aims to give as many children as possible the opportunity to go to preschool. *attending CCS funded centres e.g., a long-day care or family daycare as well as Jack & Jill is allowed under Jack & Jill’s policies.*

Acknowledged
The maximum allowed absence is 5 consecutive weeks of school term time. If my family plans an absence longer than 5 weeks of term once enrolled, I understand that my child’s enrolment will cease and they will be returned to the waiting list.*

Acknowledged
I understand that under the NSW Public Health Act, my child can only be enrolled if they are fully vaccinated for their age; have a medical reason not to be immunised; or are on a recognised catch-up schedule.*

Acknowledged
I will contact The Jack & Jill Kindergarten at administration@jackandjillkindergarten.com.au or on (02) 9477 3572 if my contact details or any other information submitted in this application needs to be updated.*

Acknowledged
Waitlist Fee
Please pay the $30 Waitlist fee by making the payment and then clicking 'Submit' below.

Please note:
- Your child will be registered on our waiting list as at the date we receive your $30 payment (*or effective from your child’s second birthday if they have not yet turned 2); and
- This application and fee does not guarantee my child a position and this fee is not refundable.

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Please verify that you are human*
Payment Name
Amount
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Payment Type
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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)
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Current Date

YearMonthDay
Date
Copy Attendance Year for calcs
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Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

The Jack & Jill Kindergarten (Hornsby)

Attendance Preference

Priority of Access

Returning Families

Additional Information

Submission Declaration

Waitlist Fee