Knox City Council - Integrated Registration Form

Central Registration for Participating Kindergartens

Registration for 3YO and 4YO Kindergarten
Deferral Form

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Please note if you are interested in attending Funded Kindergarten in Long day care, please visit this link to complete the Long day Care registration form.
What year would you like your child to commence kindergarten?
What year would you like your child to commence kindergarten? *
Mapped Care Period *
Is this application for 3YO or 4YO Kindergarten?*
Child's Details
Child's Name*

First NameLast Name
Child's Date of Birth*

DayMonthYear
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. Contact the Central Registration team for further information.
Gender*

MaleFemaleOther
Child's Residential Address*
Child's Living Arrangement*

Both parentsParent / Guardian 1Parent / Guardian 2Formal Kinship CareFoster CarePermanent CareResidential CareInformal Kinship Care
Parent's Details

Please be advised all correspondence will be sent to Parent / Guardian 1.
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Does the family require an interpreter?*

YesNo
Parent / Guardian 1 language
Does this parent live at the same address provided for the child?

Same as childDifferent address
Parent's Residential Address
Phone Number*
Mobile preferred
Email*
All correspondence will be sent to this email address
Does Parent / Guardian 1 hold a Commonwealth Health Care Card?*

YesNo
Health Care Number*
Health Care Expiry Date*

DayMonthYear
Please attach a copy of your Health Care card*

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Does Parent / Guardian 1 hold a Commonwealth Pensioner Concession Card?*

YesNo
Pensioner Number*
Pensioner Card Expiry Date*

DayMonthYear
Please attach a copy of your Pensioner Concession card*

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Does Parent / Guardian 1 hold a Veterans Affairs Card?*

YesNo
Department of Veterans Affairs Number*
Department of Veterans Affairs Expiry Date*

DayMonthYear
Please attach a copy of your Veterans Affairs card*

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Does Parent / Guardian 1 have a NDIS number or are they undergoing assessment for disability under the NDIS currently?*

YesNo
NDIS number
Does Parent / Guardian 1 have complex medical needs that present barriers to accessing a kindergarten program (supported by a letter from a medical practitioner or specialist)?*

YesNo
Please provide further details*

0/230
Please attach a copy of the assessment or letter*

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Would you like to add a second parent / guardian?*

YesNo
Parent / Guardian 2*

First NameLast Name
Relationship to the child*
Does this parent live at the same address provided for the child?

Same as childDifferent address
Residential Address
Phone Number*
Mobile preferred
Email*
Please Note: You will be notified of all correspondence via email
Does Parent / Guardian 2 hold a Commonwealth Health Care Card?

YesNo
Health Care Number*
Health Care Expiry Date*

DayMonthYear
Please attach a copy of your Health Care card*

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Does Parent / Guardian 2 hold a Commonwealth Pensioner Concession Card?

YesNo
Pensioner Number*
Pensioner Card Expiry Date*

DayMonthYear
Please attach a copy of your Pensioner Concession card*

Browse Files

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Does Parent / Guardian 2 hold a Veterans Affairs Card?

YesNo
Department of Veterans Affairs Number*
Department of Veterans Affairs Expiry Date*

DayMonthYear
Please attach a copy of your Department of Veterans Affairs card*

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Does Parent / Guardian 2 have a NDIS number or are they undergoing assessment for disability under the NDIS currently?*

YesNo
NDIS number
Does Parent / Guardian 2 have complex medical needs that present barriers to accessing a kindergarten program (supported by a letter from a medical practitioner or specialist)?*

YesNo
Please provide further details*

0/230
Please attach a copy of the assessment or letter*

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Priority of Access - Additional Information
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)
Are you a Knox resident*

YesNo
Please upload proof of your home address (eg. rates or utility bill)*

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Do you have a connection to the City of Knox through work or study?*

YesNo
Please attach proof of work or study in Knox*

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Is this child Aboriginal or Torres Strait Islander?*

NoTorres Strait IslanderAboriginalBoth Aboriginal and Torres Strait Islander
Please indicate if you are eligible for one of the following concessions, or meet one of the following criteria:

Refugee 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)Current or expired ImmiCard
Does your child hold a Commonwealth or Disability Health Care Card?*

YesNo
Health Care Number*
Health Care expiry date*

DayMonthYear
Please attach a copy of the Health Care card*

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Is this child a multiple birth (triplet or quadruplet or more)?*

YesNo
Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found here.
Does your child have a medical condition, an additional need or is currently undergoing assessment for an additional need?*

YesNo
If yes, please specify:*
Please include a support letter from a medical doctor or specialist. If your child is accessing NDIS, please include a copy of the support plan.*

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DNU_If yes, please select which of the following applies*

Child eligible or undergoing assessment for a disability under the NDISChild eligible for Early Childhood Intervention Service Continuity of SupportChild diagnosed with a disability or developmental delay or undergoing diagnosisChild with developmental concerns that presents barriers to accessing a kindergarten programChild has complex medical needs that presents barriers to accessing a kindergarten programChild previously accessed Kindergarten or Commonwealth Inclusion Support or similar programReferred by NDIS or Early Childhood Intervention or Preschool Field Officer or MCH nurse or similar
Is your child registered with a specific Support service / agency?*

YesNo
Is your child accessing NDIS or has been referred by one of the following? Early Childhood Intervention Service (ECIS), Preschool Field Officer, Maternal and Child Health Nurse?*

YesNo
Name of support service / agency*
max 255 characters
Please provide details of your case workers name and contact details*
max 255 characters
Is this child or family known to child protection, Orange Door, or has been referred to family support services or out of home care?*

YesNo
If yes, please select from the following:*

Experiencing family violence or has had contact with The Orange DoorKnown to or had contact with Child Protection or in Out-of-Home-CareChild or family previously accessed Flexible Support PackagesReferred by Child Protection, Child and Family services, MCH nurse, Out of Home Care provider
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 specify details*
Second Year of Funded Kindergarten

Children enrolled in a funded kindergarten program are eligible to access a repeat year of funded 3 or 4 year old kindergarten, only if the early childhood teacher has assessed eligibility for your child to be considered for a second year.
Is your child applying for a second year of funded {programTypeforRepeatsQ}?*

YesNo
Where did your child previously attend Kindergarten?*
max 255 characters
Knox Connection
Does your child have a sibling who is currently attending or attended in the previous 3 years to your 1st preferenced kindergarten?*

YesNo
Sibling Details*
Does your child attend Long Day Care at one of the following Knox Children and Family Centres?*

BayswaterWantirna SouthDoes not attend Long Day Care at either centre
Is your child currently attending any of the following Kindergartens?*

Alchester Village KindergartenColchester Park PreschoolKinderlea PreschoolNo
P1 eligible?
P2 eligible?
input_PPPC
Pre Prep Priority Cohort
Privacy Collection Notice
The personal information requested on this form is being collected by Knox City Council 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.

Personal, health, wellbeing and developmental information may be shared with relevant government departments and organisations including, but not limited to, the Department of Education, Municipal Association of Victoria, Knox City Council Maternal Child Health Nurses, Knox City Council Preschool Field Officers, medical, Allied Health and Specialist Support Service professionals. Information may also be shared under approved schemes including, but not limited to, the Family Violence Information Sharing Scheme and Child Information Sharing Scheme. It will not be disclosed to any other external party without your consent, unless required or authorised by law.

If the information requested on this form is not collected, Council will be unable to allocate a funded sessional kindergarten place.

Requests for information about what data is shared, access to and/or amendment of personal information, please contact the Early Years Registration and Support Officers via telephone 9298 8000 or email kindergarten@knox.vic.gov.au or contact Council’s Chief Privacy Officer.

Personal information will be stored with EnrolNow Pty Ltd ABN 711 497 11580 which is located in Australia for the purpose of registration, allocation and enrolment to participating funded sessional kindergarten programs.
Authorisation and Declaration
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.
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Yes
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Date

DayMonthYear
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Cutoff Date

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Central Registration for Participating Kindergartens

Child's Details

Parent's Details

Priority of Access - Additional Information

Knox Connection

Privacy Collection Notice

Authorisation and Declaration