Loddon Shire

Loddon Shire

Central Enrolment for Funded Kindergarten
Deferral Form

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Child's Details
Child's Name*

First NameLast Name
Gender*

MaleFemaleUnspecified
Child's Date of Birth*

DayMonthYear
Please attach confirmation of your child’s date of birth

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Child's Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Please upload proof of address (eg. rates or utility bill)

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Primary language spoken at home
Parent's Details
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Phone Number*
Mobile preferred
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*
Phone Number*
Mobile preferred
Email*
Additional information about your child
By completing the following information, you will help our team support your family. This information will also be used to access priority of access for a kindergarten placement
Do any of the below apply to you or your child?

Commonwealth Health Care CardCommonwealth Pensioner Concession CardTriplets or QuadrupletsAboriginal or Torres Strait IslanderCurrent or expired ImmiCardRefugee visa (subclass 200)In-country Special Humanitarian visa (subclass 201)Global Special Humanitarian visa (subclass 202)Temporary Humanitarian Concern visa (subclass 786)Protection visa (subclass 866)Emergency Rescue visa (subclass 203)Woman at risk visa (subclass 204)Bridging visa A-E for humanitarian or refugee visaHumanitarian Stay visa (subclass 449)Temporary Protection visa (subclass 785)Safe Haven Enterprise visa (subclass 790)Department of Veterans Affairs (DVA) Gold Card or White Card
Health Care Number*
Health Care expiry date*

DayMonthYear
Please attach a copy of your Health Care Card*

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Pensioner Number*
Pension Card Expiry Date*

DayMonthYear
Please attach a copy of your Pensioner Concession Card*

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Max 10MB total file size Cancelof
Please attach a copy of your visa*

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Max 10MB total file size Cancelof
Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found here.
Does your child have any additional needs*

YesNo
If yes, please specify*
max 255 characters
Is your child registered with a specific Support service / agency?*

YesNo
Name of support service / agency*
max 255 characters
Is this child or family known to child protection?*

YesNo
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
Please attach a copy of relevant documentation

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Do you consent to us accessing your child's immunisation records?*

YesNo
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.

Note: If you do not wish to provide consent, you will be required to provide a copy of your child's immunisation statement when submitting the enrolment form for kindergarten.
Kindergarten Locations
For Kindergarten locations please refer to the below map.

Please note: timetables for 2026 will be finalised based on the volume of registrations received for each kindergarten. These will be made available on this map at a later date and will be shared with families during the allocation process.
What year would you like your child to commence kindergarten? *
What program type is this application relevant to?*

Collapse Stopper
Please select a unique session time for each preference.
Authorisation and Declaration
By submitting this registration form, I understand and agree to the following:
- Acknowledge that the information provided on this form is true and correct to the best of my knowledge.
- I understand that this form is a legal document and penalties exist for providing false or misleading information
- I acknowledge that the Council accepts this future kindergarten registration form on behalf of participating kindergartens but gives no guarantee that a place will be available in the kindergarten nominated.
- I acknowledge that the Council will be using data from this future kindergarten registration form for future planning
Collection Notice

Loddon Shire Council is committed to protecting your privacy. The personal information you provide on this form is being collected for the primary purpose of registering your child for kindergarten.

Information provided will be accessed by Early Years Staff to enable them to process your child’s enrolment and provide education and care for your child.

For further information on the Department’s Privacy Policy, visit www.education.vic.gov.au/pages/privacypolicy.aspx

Should you wish to access or modify this information, please contact Council on (03) 5494 1200 or email loddon@loddon.vic.gov.au
Already Paid?

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Program Type Input
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Child's Details

Parent's Details

Additional information about your child

Kindergarten Locations

Authorisation and Declaration