CHILD'S DETAILS
First Name / Family Name
Gender (circle or highlight) / Male / Female / Date of Birth
Is your child?(circle or highlight) / Twin Triplet Quadruplet
Is your child?(circle or highlight) / Aboriginal Torres Strait Islander
Is your child living in Out of Home Care or Kinship Care? E.g. Living with a grandparent/relative? (circle or highlight) / Yes / No
If yes, please specify who:
Please note that the information you provide below is given to the Kindergarten Provider to assist them to support the inclusion of children with additional needs participating in 4-year-old Kindergarten programs.
Does your child have an additional need which may require specialist assistance to attend kindergarten? E.g. Speech Therapy? (circle or highlight) / Yes No Unsure
If yes or unsure, please provide further information:
Has your child been involved in any developmental support programs? E.g. Speech Therapy, physiotherapy? (circle or highlight) / Yes / No
If yes, please provide further information:
Does your child have any Allergies/Medical Conditions? E.g. Asthma or allergies, need to use hearing aids, walking frames (circle or highlight) / Yes / No
If yes, please provide further information:
Has your child previously attended a funded 4-year-old kindergarten program? (circle or highlight) / Yes / No
If yes to above, please provide details of the service attended (name and phone number):
Has your child been formally assessed as requiring a second year of funded 4-year-old kindergarten? (circle or highlight) / Yes / No
Has your child had their 3.5yo Maternal and Child Health check? (circle or highlight) / Yes / No
Would you like Maternal & Child Health to contact you to make this appointment? (circle or highlight) / Yes / No
PARENT/GUARDIAN INFORMATION
PARENT/GUARDIAN DETAILS(Main Contact person)
Title / Mrs Ms Miss Mr / Relationship to child
First Name / Family Name
Mobile Number / Home number
Email address
Home address
Mailing Address
Language(s) spoken at home
Do you need an interpreter? / Yes / No
Is your family receiving support and assistance from a Child and Family Service agency? / Yes / No
If yes to above, please provide details of the service (name and contact person):
PARENT/GUARDIAN DETAILS
Title / Mrs Ms Miss Mr / Relationship to child
First Name / Family Name
Mobile Number / Home number
Email address
Home address
Mailing Address
Language(s) spoken at home
Do you need an interpreter? / Yes / No
APPLICATION INFORMATION
Are you a resident/rate payer of the Moorabool Shire? / Yes / No
If yes to above, please attach proof of your residency (Rates Notice, Lease Agreement, Land Sale, Drivers Licence)
Please note: Kindergarten applications received from non-residents are assessed on a case-by-case basis in January of the year your child will attend kindergarten, and application fees are non-refundable.
Do you have a Health Care Card, Veteran’s Affairs Gold, White Care or Pension Card? / Yes / No
If yes to above, please specify: / Card type: / Card number:
KINDERGARTEN PREFERENCE
Please number the boxes below in order of your preference 1-5:
/ Young Street Kindergarten
Cnr Young & Bennett Streets
Bacchus Marsh
Telephone: (03) 5367 2443 / / Darley Kindergarten
Darley Early Years Hub
182 Halletts Way, Darley
Telephone: (03) 5367 2206 / / Montessori Kindergarten
176 Gisborne Road
Darley
Telephone: (03) 5367 7706
/ Wallace & District Kindergarten
739 Bungaree—Wallace Road
Wallace
Telephone: (03) 5334 0268 / / Ballan Kindergarten
88 Simpson Street
Ballan
Telephone: (03) 5368 1228
CHECKLIST
☐I have read and understand the information provided in the Moorabool Shire Council 4-Year-Old Kindergarten
Central Enrolment Booklet.
☐I have attached my proof of address as a resident/rate payer of Moorabool Shire.
☐ I have included payment of a non-refundable application fee $22.00** by enclosing a cheque or money order (made
payable to Moorabool Shire Council.) In person via cash, credit or EFTPOS at a Council Office.
Please note: Applications received without payment and/or the required documentation will be deemed incomplete and will not be processed until your payment has been received.
Please note: After accepting a kindergarten place with Council and upon enrolment with the kindergarten, you will be required to provide verification of your child’s date of birth and immunisation status. This will need to be done prior to your child attending the service. You can request an ‘Immunisation Status Certificate’ from the Australian Immunisation Register (AIR) via telephone on 1800 653 809. Email or visit or visit a Medicare Service Centre.
Please note: Application Fee will increase to $23.00 from 1 July 2018
Change of Details & Preference
You can change your Kindergarten Preference by advising Council in writing, via post, to the postal address listed below or via email to please outline your child’s name, preference change and the reason for the change.
You are required to advise Council if your contact details change at any time during the enrolment process, applicants must notify Council of changes in writing via letter returned to the postal address listed below or via email
Placement Allocation Process
Applications for first round offers close on 29June 2018. First round offers will be emailed in July 2018. Applications received after 29 June will go into the second round offers made in September 2018.
Applications received after the first and second round offers will be allocated to available kindergarten places according to their preferences. If no places are available the applicant will be placed on a waiting list according to Priority of Access and the date the application was received.
Declaration
I, being the Parent/Legal Guardian, confirm my application for my child’s four-year-old kindergarten enrolment into Moorabool Shire Council’s Central Enrolment System. I declare that the information provided by me is true and correct. I further acknowledge that where incorrect information has been provided on the Application Form offers for a kindergarten place will be withdrawn. I understand that if my application is deemed incomplete it will not be processed until the required payment and information is received by Council.
Name of Parent/Legal Guardian: ______Signature: ______
Relationship to child: ______Date: ______