Kingston City Council Kindergarten Central Registration Form

• Application Year

• To be eligible for four year old sessional funded kindergarten children must turn four years of age by 30 April in the year they wish to attend.
• Application Year 2020 2021

• Birth date is outside the range for year selected. Please check birth date/year and proceed.
• Male Female

• Multi Birth

• Is the child a triplet/quad who is attending in the same year as their siblings?
  
  Yes No
• Is the child a twin attending in the same year as their siblings?
  
  Yes No

• At Risk/Vulnerable/Out of Home Care

• Is the child at risk of abuse or neglect or in out of home care?
  
  Yes No
• Please upload written confirmation of one the following documents:

  Eligibility for Early Start Kindergarten or Access to Early Years
  Letter of referral from child or family service agency
  Statement from parent or guardian

  Supporting Documentation At Risk/Referral:
  JPG or PDF Format. Max 2MB

• Family Services

• Does the child/family have a case manager / family support worker or disability worker?
  
  Yes No
  Case Agency Department of Human Services Brotherhood of St Lawrence Child FIRST Early Intervention Specialist Services KU Children’s Services Noah’s Ark Yooralla NDIS service provider Orange Door Enhanced Maternal and Child Health Scope Uniting Other
  

  Phone

  Mobile

• Indigenous Status

• Does the child identify as Aboriginal or Torres Strait Islander?
  
  Yes No

• Additional Needs of the child

• Does the child have a disability or development delay?
  
  Yes No

• 2nd Year of Kindergarten

• Is this the second year of funded 4 year old kindergarten for the child?
  
  Yes No

• Early Start Kindergarten

• Is this an Early Start Kindergarten application for the child?
  
  Yes No

• Title... Mr Mrs Ms Miss Dr Prof

• Postal address (if different from above)

• Home Phone

  Business Phone

  Mobile Phone

• Email addresses entered must match
• Relationship to child... Aunt Father Grandfather Grandmother Mother Step father Step mother Uncle
• Language Spoken Afrikaans Albanian Alywarr Arabic Armenian Arrernte (Aranda) Assyrian (including Aramaic and Chaldean) Australian Indigenous Languages Bengali Bisaya Bosnian Bulgarian Burarra Burmese Cantonese Cebuano Celtic, nec Celtic, nfd Chaldean Chinese Creole Croatian Czech Danish Dari Eastern Asian Languages Eastern European Languages English ------------------------------ Estonian Fijian Filipino Finnish French Gaelic/Scottish German Gilbertese Greek Gujarati Hakka Hebrew Hindhi Hindi Hmong Hokkien Hungarian Icelandic Indonesian Iranic, nfd Irish Italian Japanese Kannada Karen Khmer Korean Kriol Kurdish Kuurinji (Gurindji) Lao Latvian Lithuanian Macedonian Malay Malayalam Maltese Mandarin Mauritian Creole Nepali Netherlandic/Dutch Non Verbal (inc. Sign Language eg. Auslan Makaton) Northern European Languages Norwegian Not stated/inadequately described Other Languages Pashto Persian Pintupi Pitjantjatjara Polish Portuguese Punjabi Romanian Russian Samoan Serbian Singhalese Sinhalese Slovak Slovene Somali Southeast Asian Languages Southern Asian Languages Southern European Languages Southwest And Central Asian Languages Spanish, Swahili Swedish Tagalog Tamil Telugu Teochew Thai Tibetan Timorese Tiwi Tongan Turkish Ukrainian Urdu Vietnamese Walmadjari Warlpiri Welsh Wik-Mungkan Yiddish
• Will the child's family/carer require an interpreter?
  Yes No
• I would like to enter details for a second parent/guardian

Preference options will be shown once you have selected your Application Year above

We encourage you to select up to 3 preferences in the event your preferred Kindergarten is full, however please only select preferences you would be willing to accept.
We recommend you visit your local kindergartens to ensure that the program is suitable for you and your child(ren).

• Individual circumstances will affect priority of access to kindergarten. Read the Priority of Access and Offer Policy Guide before proceeding.

• Resident/Non Resident with a Connection

• Do you live within a 2km radius of your first preference kindergarten?
  
  Yes No
• Are you a resident of the City of Kingston?
  
  Yes No
• Do you have a connection to the City of Kingston through work,study or childcare?
  
  Yes No

• Prior Connection

• Has the child or sibling had a prior connection to your first preference in the last 3 years?
  
  Yes No
  Select who had prior connection... Applicant Sibling
  

• Concession/Visa Cards

• Do you or your child hold a current health care card, concession card, humanitarian/refugee or bridging visa?
  Yes No
• Card TypeCommonwealth Health Care Card Commonwealth Pension Concession Card Emergency Rescue Visa (Subclass 203) In-Country Special Humanitarian Visa (Subclass 201) Global Special Humanitarian Visa (Subclass 202) Protection Visa (Subclass 866) Veteran Affairs Gold or White Refugee Visa (Subclass 200) Women at Risk Visa (Subclass 204) Temporary Humanitarian Concern Visa (Subclass 786) Bridging Visa A-E
  
  
  
  
  Proof of Concession Card/Visa:
  JPG or PDF Format. Max 2MB

Additional comments to support your application

• By submitting this application the parent/guardian agrees and understands:
  • All information provided by me may be audited at anytime and the application will be reallocated if incorrect.
  • I will provide information and supporting documentation if requested
  • Failure to provide complete and correct information may result in this application being excluded in the allocation process.
  • I can be contacted by Council with information regarding relevant events, issues and services.
  • This is an application form, not a guarantee of placement. Offers for kindergarten places will be made July prior to the application year.
• I understand and agree to all the points above.

• Personal information being collected on this form is being used by Council for the purpose of planning current and future kindergarten services in Kingston. The information will be used solely by Council and its contracted service providers for that purpose or a directly related purpose. Council may disclose this information to other organisations if required or permitted by legislation. The information shall remain private and confidential within Council and will only be disclosed to other persons or agencies as consented by the enrolling parent/guardian or they may apply to Council’s Privacy Officer in writing for access and/or amendment of the information. A full copy of Council’s Privacy Policy may be obtained from the Kingston website.
• Please note that documented proof of living, working, studying or using child care in Kingston is required upon request to confirm your priority level when allocating places. If a copy is provided to Council, that document will be securely destroyed once sighted.