LEN JEFFREY MEMORIAL PRESCHOOL

LEN JEFFREY MEMORIAL PRESCHOOL

Kindergarten Application Form
Child's Name*

First NameLast Name
Child's Date of Birth*

DayMonthYear
Birth Certificate*

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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
Do you have children that have previously attended Len Jeffery Memorial Preschool?

YesNo
Do you work or live in the city of Belgrave South?

YesNo
Enrolment & Immunisations
Has your child been immunised and is the schedule up to date? *

YesNo
My child has had all their 4 Year Old Immunisations as per the attached immunisation statement.*

YesNo
What date is your child due for their next immunisation?*

DayMonthYear
Please attach your child's immunisation record*

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Under the ‘No Jab, No Play’ legislation, before enrolling a child, early childhood education and care services have to first obtain evidence that the child is up to date with all vaccinations that are due for their age, or that they are able to receive.

An Immunisation History Statement from the Australian Immunisation Register (AIR) is the only form of documentation accepted for the purpose of enrolling in an early childhood education and care service.

After enrolment, parents will need to continue to provide up to date Immunisation History Statements to their child’s early childhood service, if their status changes.

You can get your immunisation history statement straight away by accessing your medicare online account via my.gov.au

If you can't use Medicare online, we can print your immunisation history statement for you.

You can also call the AIR enquiries line (1800 653 809) and ask them to send your immunisation history statement to you. It can take up to 14 days to arrive in the post.

Please note: Only Immunisation History Statements from the Australian Immunisation Register will be accepted as evidence of immunisation.
Kinder Fee Subsidy

DET provides a fee subsidy for eligible families
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 Special Needs
Does your child have any special 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:
Kindergarten Preferences
What year would you like your child to commence care? *
What program type is this application relevant to?*
Warning: Your Application is unable to be accepted at this time.

Based on the Date of Birth for your child, your registration does not meet the age criteria for the year you have requested.
Preference One
Send Notification?*
Security Deposit
This Security Deposit is refundable at the end of term 1 - once child has commenced kindergarten.*
*Non-refundable – if families decline offer to kindergarten.

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
Cutoff date calculator
Cutoff Date

DayMonthYear
Date
Age as at cutoff
ineligible to apply
Deferral Form

Yes
Should be Empty:

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Enrolment & Immunisations

Kinder Fee Subsidy

Children with Special Needs

Kindergarten Preferences

Security Deposit