Temora Preschool and OOSH
EOI Application Form
Deferral Form
Yes
Program Type
Child's Name
*
First name
Last name
Gender
*
Male
Female
Other
Child's date of birth
*
-
Day
-
Month
Year
Parent / Guardian 1
*
First name
Last 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
City
State / Province
Postal / Zip Code
Preferences for Care
What year does this registration apply for?
2025
2026
What year does this registration apply for?
2025
2026
Mapped Care Period
*
2025
2026
3YO Preschoolers
Preference One
*
2 Days - Mon, Fri
Preference Two
2 Days - Mon, Fri
3 Days - Mon, Tues, Wed
3 Days - Tues, Wed, Thurs
2 Days - Thurs, Fri
4YO+ Preschoolers
Preference 1
*
3 Days - Mon, Tues, Wed
3 Days - Tues, Wed, Thurs
2 Days - Thurs, Fri
Preference One
2 Days - Mon, Fri
3 Days - Mon, Tues, Wed
3 Days - Tues, Wed, Thurs
2 Days - Thurs, Fri
Preference 2
*
3 Days - Mon, Tues, Wed
3 Days - Tues, Wed, Thurs
2 Days - Thurs, Fri
Preference 3
*
3 Days - Mon, Tues, Wed
3 Days - Tues, Wed, Thurs
2 Days - Thurs, Fri
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Additional Information
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
*
-
Day
-
Month
Year
Please attach a copy of the Health Care Card
*
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Pensioner Concession Card Number
*
Pensioner Concession Card expiry date
*
-
Day
-
Month
Year
Please attach a copy of the Pensioner Concession Card
*
Browse Files
Cancel
of
Department of Veterans Affairs Number
*
Department of Veterans Affairs expiry date
*
-
Day
-
Month
Year
Please attach a copy of the Veterans Card
*
Browse Files
Cancel
of
Does this child identify as Aboriginal / Torres Strait Islander?
*
No
Torres Strait Islander
Aboriginal
Both Aboriginal and Torres Strait Islander
Does your child have any additional needs?
*
Yes
No
If yes, please specify:
*
0/255
Which of the following relevant professionals made the assessment?
*
Please Select
General Practitioner (GP)
Early childhood teacher or primary teacher with an additional qualification in Special Education
A professional qualified to administer psychometric assessments
Audiologist
Occupational therapist
Paediatrician
Psychiatrist
Registered psychologist
Speech pathologist
Other
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?
*
Yes
No
NDIS Number:
*
Will your child require additional support in understanding and communicating in English language at preschool?
*
Yes
No
Language used by your child (other than English):
*
Please Select
Aboriginal and Torres Strait Islander Languages & Dialect
Augmentative and Alternative Communication (ACC) (Such as Auslan, Key Word Sign systems, or Gestures)
Mandarin
Arabic
Cantonese
Vietnamese
Filipino/Tagalog
Hindi
Spanish
Greek
Nepali
Italian
Other
Is your child at risk of harm?
*
Yes
No
Does this child have a sibling who has previously attended this preschool?
*
Yes
No
Please enter sibling details (First Name, Last Name, Year of Attendance)
*
Send Notification?
*
Please Select
Yes
No
Submit
Payment Name
Amount
Calculated Amount for Stripe Widget
Payment Type
Credit Card
Direct Deposit
alreadyPaid
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Program type
*
Mixed Age
31July in year of commencement
31 July in year of commencement convert to date format
-
Year
-
Month
Day
Date
Age at 31July starting year
ATSI Output
HCC Output
PCC Output
DVA Output
Concessions Calculator
Concessions
Aboriginal or Torres Strait Islander
Bridging visa A-E for humanitarian or refugee visa
Commonwealth Health Care Card
Commonwealth Pensioner Concession Card
Current or expired ImmiCard
Department of Veterans Affairs (DVA) Gold Card or White Card
Emergency 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 Quadruplets
Woman at risk visa (subclass 204)
EF Item_ [Add Item Number]
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Current Date
-
Year
-
Month
Day
Date
Copy Attendance Year for calcs
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