Enrolling for your child to attend kindergarten in(please tick): ☐2017 or ☐2018
Child’s Information
First Name: ______Surname: ______
Gender: ☐Boy☐Girl Date of Birth: ______
Is your child a? ☐Twin ☐Triplet ☐Quadruplet
Please note: you are required to complete a separate application for each child.
Is your child of Aboriginal or Torres Strait Islander Descent?
☐ Yes Torres Strait Islander☐Yes, both Aboriginal and Torres Strait Islander
☐ Yes Aboriginal☐ No, not Aboriginal nor Torres Strait Islander
Is your child living in Out of Home Care or Kinship Care? e.g. Living with a grandparent/relative?
☐Yes ☐ No If Yes, please specify who: ______
Has your child been formally assessed as requiring a second year of funded 4-year-old kindergarten? ☐ Yes ☐ No
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? ☐Yes ☐No ☐ Unsure If Yes or Unsure please provide further information: ______
Has your child been involved in any developmental support programs?☐Yes ☐ No
e.g. Speech therapy, physiotherapy. If Yes, please provide further information: ______
Does your child have any Allergies/Medical Conditions?☐Yes ☐ No
e.g. Asthma or allergies, need to use hearing aids, walking frames. If Yes, please provide further information:______
Has your child previously attended a funded 4-year-old kindergarten program?☐Yes ☐ No
If yes to above, please provide details of the service attended (name and phone number):
______
Has your child had their 3.5yo Maternal and Child Health check? ☐Yes ☐ No
Would you like to make a Maternal & Child Health appointment? ☐Yes ☐ No
Parent/Guardian 1(Main Contact)
Title: ☐ Mrs ☐Ms ☐Miss ☐ Mr Relationship to child: ______
First Name: ______Surname: ______
Mobile Number: ______Home Phone: ______
Email: ______
Street Address: ______
Town: ______State: ______Post Code: ______
Would you like to receive all correspondence in regards to your application via email? ☐ Yes ☐No
Mailing Address (if different from above): ______
Town: ______State: ______Post Code: ______
Language spoken at home:______Do you require an interpreter? ☐Yes ☐No
Is your family receiving support and assistance from a Child and Family Service agency? ☐Yes ☐No
Service Name: ______Contact Person: ______
Parent/Guardian 2
Title: ☐ Mrs ☐Ms ☐Miss ☐ Mr Relationship to child: ______
First Name: ______Surname: ______
Mobile Number: ______Home Phone: ______
Email: ______
Street Address: ______
Town: ______State: ______Post Code: ______
Would you like to receive all correspondence in regards to your application via email? ☐ Yes ☐No
Mailing Address (if different from above): ______
Town: ______State: ______Post Code: ______
Language spoken at home:______Do you require an interpreter? ☐Yes ☐No
Application Information
Are you a resident/rate payer of the Moorabool Shire? ☐Yes ☐No
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 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, please specify? Card: ______Card Number: ______
Kindergarten Preference
Please number the boxes below in order of your preference 1-4:
Young Street KindergartenDarley Kindergarten
Cnr Young & Bennett Streets, Darley Early Years Hub
Bacchus Marsh 182 Halletts Way, Darley
Telephone: (03) 5367 2443 Telephone: (03) 5367 2206
Wallace & District KindergartenBallan Kindergarten
739 Bungaree—Wallace Road, Wallace88 Simpson Street, Ballan
Telephone: (03) 5334 0268 Telephone: (03) 5368 1228
Check List
☐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 Childhood Immunisation Register (ACIR) via telephone on 1800 653 809. Email visit or visit a Medicare Service Centre.
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
First round offers will be made on 30th June the year prior to attendance. Applications received after 30th June will go into the second round offers made in September 2017.
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: ______