LEN JEFFREY MEMORIAL PRESCHOOL

Child's Name*

First NameLast Name

To be eligible for three or four-year-old kindergarten children must be three or four by 30 April in the year they commence. Please note Children are unable to commence until they turn 3.

Child's Date of Birth*

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

Our kindergarten service 16 week grace period requires physical evidence from 1 of the following: ORANGE DOOR, child protection or DFFS. Please note the 16-week period commences when your application of enrolment is submitted.

The personal information requested on this form is being collected by Len Jeffrey Memorial Preschool for the purpose of:

Registration and allocation of kindergarten places as per the Department of Education Priority Access Criteria and local requirements,
seeking updated information of kindergarten requirements,
providing updates about the allocation process and/or
directly related secondary purpose(s).

The personal information will be disclosed to the kindergarten service provider(s) operating kindergarten services preferenced on this form, or subsequent forms, for the purpose of enrolling children to funded sessional kindergarten places. All service providers are governed by Victorian privacy laws.

If the information requested on this form is not collected, Len Jeffrey Memorial Preschool will be unable to progress the application of enrolment and allocate a funded sessional kindergarten place.

By submitting this registration form, I understand and agree to the following:

All information provided by me is true and correct
All information provided by me may be audited at any time. This registration or subsequent kindergarten allocation could be reallocated or withdrawn if the information is incorrect
Failure to provide complete and correct information may result in the registration being excluded from the allocation process
This is a registration form and does not guarantee a three or four-year-old kindergarten or long daycare placement
Three and four-year-old kindergarten places are allocated separately. Every effort will be made to place my child at the same service for four-year-old kindergarten. However, there is no guarantee of this.

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?*

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.

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

Does your child have any special/ additional needs*

YesNo

If yes, please provide more details:*

Does your child have a diagnosed disability / developmental delay?*

YesNo

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:

Are there any court orders relating to the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child?*

YesNo

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?*

This Security Deposit is refundable at the end of term 1 - once child has commenced kindergarten.*
*Non-refundable – if families decline offer to kindergarten.

My Products

Security Hold$100.00AUD

Total $0.00AUD

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

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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

Date

Age as at cutoff

ineligible to apply

Deferral Form

Yes

Enrolment & Immunisations

Kinder Fee Subsidy

Children with Special/ Additional Needs

Kindergarten Preferences

Security Deposit