Emerge Early Years Services - 2 Step Application Form with DE Changes

  • Registration Form

    Emerge Early Years Services

  • A child must be three or four years old on or before 30 April in the year they are due to attend kindergarten. The Starting Kindergarten age calculator provides information on when your child is eligible to attend kindergarten.

  • 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. Please refer to our Registering for Council kindergarten web page. 

  • Would you also like to add an application for 4 Year Old Kindergarten for the following year at this time?*

  • Please note: selecting YES to the above question will register the same kindergarten preferences for both 3 & 4 year old kindergarten. If you require different preferences, please submit a separate registration for 3-year-old and 4-year-old kindergarten.

  • Child details

  • Child's Date of Birth*
     - -
  • Gender*
  • Child's Living Arrangement*

  • Parent / Guardian details

  • Parent / Guardian 1's Date of Birth*
     - -
  • Does Parent / Guardian 1 hold a Commonwealth Health Care Card?*
  • Health Care Expiry Date*
     - -
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  • Does Parent / Guardian 1 hold a Commonwealth Pensioner Concession Card?*
  • Pensioner Card Expiry Date*
     - -
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  • Does Parent / Guardian 1 hold a Veterans Affairs Card?*
  • Department of Veterans Affairs Expiry Date*
     - -
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  • Does Parent / Guardian 1 have a NDIS number or are they undergoing assessment for disability under the NDIS currently?*
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  • Does Parent / Guardian 1 have complex medical needs that present barriers to accessing a kindergarten program?*
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  • Would you like to add a second parent / guardian?*
  • Parent / Guardian 2's Date of Birth*
     - -
  • Parent / Guardian 2 Address*
  • Does Parent / Guardian 2 hold a Commonwealth Health Care Card?*
  • Health Care Expiry Date*
     - -
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  • Does Parent / Guardian 2 hold a Commonwealth Pensioner Concession Card?*
  • Pensioner Card Expiry Date*
     - -
  • Browse Files
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  • Does Parent / Guardian 2 hold a Veterans Affairs Card?*
  • Department of Veterans Affairs Expiry Date*
     - -
  • Browse Files
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  • Does Parent / Guardian 2 have a NDIS number or are they undergoing assessment for disability under the NDIS currently?*
  • Browse Files
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  • Does Parent / Guardian 2 have complex medical needs that present barriers to accessing a kindergarten program?*
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  • Immunisations

  • The Government’s No Jab No Play laws require all children to be age-appropriately immunised before enrolment can be confirmed. Further information on immunisation requirements for enrolment in early childhood services is available on the State Government's Better Health Channel at www.betterhealth.vic.gov.au/campaigns/no-jab-no-play

  • Are your child's immunisation up to date?*

  • 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)

  • Is this child Aboriginal or Torres Strait Islander?*
  • Does your child hold a Commonwealth or Disability Health Care Card?*
  • Health Care expiry date*
     - -
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  • Is this child a multiple birth (triplet or quadruplet or more)?*
  • Is your child or family known to child protection or connected with the Department of Families, Fairness and Housing or any other support services (eg. Orange Door, Anglicare, Uniting)?*
  • If yes, please select from the following:*
  • Do you or your child have, or are you applying for, any of the following visas?

  • Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found here.

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  • Does your child have any additional needs*

  • You are encouraged to discuss your child's needs with the educator when your child's place is confirmed.

  • Maternal & Child Health Details

  • Has your child attended their Maternal Child Health key age and stage assessment?

  • 2 year old assessment*
  • 3 1/2 year old assessment*
  • Do you give permission for Maternal Child Health to share your child's health and development information from Maternal Child Health key age and stage visits (including PEDS or Brigance assessment) with the Kindergarten Teacher if required?
  • Have you attended a Supported Play Group and Parent Group (SPPI) in the previous year?
  • Are you currently attending a Supported Play Group and Parent Group
    • Prior Connection 

    • Prior Connection

    • Do you have any children that have previously attended 4 YO first preference?*
    • End section 

    • Kindergarten Preferences

    • Horsham 
    • Hindmarsh 
    • Stawell 
    • End Stopper 
  • Cutoff Date
     - -
  • Should be Empty: