LMPA - Registration Form - Pre Prep Groups and Extended Prefs

Loddon Mallee Preschool Association

Central Enrolments 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
Parent's Details
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number*
Mobile preferred
Email*
Please Note: You will be notified of all correspondence via email
Primary language spoken at home*
Does Parent / Guardian 1 require an interpretter?*

YesNo
Kindergarten Funding Questions

Please note: the collection of this information is a requirement of the Victorian Government as part of the Early Childhood Reform Plan.

Occupation Group: More details

Please select the appropriate parental occupation group from the drop down menu. For more comprehensive details please refer here.
- If the person is not currently in paid work but has had a job in the last 12 months, or has retired in the last 12 months, please use their last occupation to select from the occupation groups
- If the person has not been in paid work for the last 12 months, select "N"
What is the highest year of primary / secondary school that Parent / Guardian 1 has completed?*
What is the level of the highest qualification that Parent / Guardian 1 has completed?*
What is the occupation of Parent/Guardian 1?*
What is the occupation group of Parent / Guardian 1?*
Is the family a single parent family?*

YesNo
Parent / Guardian 2*

First NameLast Name
Relationship to the child*
Parent / Guardian 2 Address*

Same as parent / guardian 1Different to parent / guardian 1
Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number*
Mobile preferred
Email*
Please Note: You will be notified of all correspondence via email
What is the highest year of primary / secondary school that Parent / Guardian 2 has completed?*
What is the level of the highest qualification that Parent / Guardian 2 has completed?*
What is the occupation of Parent / Guardian 2?*
What is the occupation group of Parent / Guardian 2?*
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 and access to additional hours for priority cohorts (as defined by the Department of Education)
Please indicate if you are eligible for one of the following concessions, or meet one of the following criteria:

Commonwealth Health Care CardCommonwealth Pensioner Concession CardRefugee 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 CardTriplets or QuadrupletsAboriginal or Torres Strait IslanderCurrent or expired ImmiCard
Health Care Number*
Health Care expiry date*

DayMonthYear
Pensioner Number*
Pension Card Expiry Date*

DayMonthYear
Please attach a copy of your concession / visa*

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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 specific healthcare needs including any medical conditions that are relevant to the care and education of the child?*

YesNo
If yes, please provide details*

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Does your child have any additional needs*

YesNo
Which of the following relevant professionals made the assessment?*
Please provide further details of your child's additional needs*
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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P1 eligible?
P2 eligible?
input_PPPC
Pre Prep Priority Cohort
Prior Connection
Does your child have a prior connection to your 1st preference by the way of sibling in the past 3 years or attended 3 Year Old Kindergarten in the year prior?*

YesNo
Please provide the name and year of attendance of siblings*

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Immunisation
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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Please select one of the following*

My child is on a recognised catch-up scheduleMy child has a medical exemptionNone of the above
Please provide a copy of your child's AIR Immunisation Medical Exemption Form that has been lodged by an eligible health practitioner with the Australian Childhood Immunisation Register*

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Please provide your child's AIR Immunisation History Form that shows your child is on a recognised catch-up schedule - temporary for 6months only*

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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

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.
Kindergarten Preferences

Funded sessional kindergarten registrations are prioritised based on the Victorian State Government's Kindergarten Guidelines, the child's prior connection and by the age of the child (oldest to youngest) to the service of their first preference
What year would you like your child to commence kindergarten? *
What program type is this application relevant to?*
Kindergarten Program Times

To view the kindergarten programs relevant for your child, please select the year and age your child will attend kindergarten

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Please select a unique session time for each preference.
Authorisation and Declaration
Privacy and Confidentiality statement

The personal information requested in this application is collected by the Kindergarten Central Registration and Enrolment System (CRES) to facilitate central enrolment and placement in early childhood education and care services within the region. This information will be used by CRES for this main purpose and other related activities, such as supporting children's transition to kindergarten and fee invoicing where applicable. All data will be kept confidential. CRES may share this information with relevant government bodies, council organisations, kindergarten managers and educators, and early years services to support the enrolment process and funding. Additionally, information about a child’s medical and additional needs will assist in their transition to kindergarten. The gathered information may also be used to ensure the fair distribution of available places across all kindergarten programs.
I declare that the information provided in this application is true and correct and I give my permission for CRES to share this information with those listed above.
Already Paid?

Yes
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Yes
Send Notification?
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Yes
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Yes
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Program Type Input
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Loddon Mallee Preschool Association

Child's Details

Parent's Details

Additional information about your child

Prior Connection

Immunisation

Kindergarten Preferences

Kindergarten Program Times

Authorisation and Declaration