Brimbank Funded Kindergarten Registration

• Application Type & Year

• - Select Application Type - 3 Year Old Preschool 4 Year Old Preschool Both 3 and 4 Year Old Preschool
• Loading Application Years
  - Select Application Year -

• Preferences

• Loading Available Sessions

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

  Please only select preferences you would be willing to accept. We encourage you to visit your local kindergartens to ensure that the program fees and hours are suitable.

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

• At Risk/Vulnerable/Out of Home Care

  Is your child known to Child FIRST or Child Protection Agency?
  Yes No
• Is your child in an Out of Home Care arrangement including kinship care?
  Yes No

• Family Services

  Does your child/family have a case manager / family support worker?
  Yes No
  Case Agency - Select - Amaze Incorporated AMES Baptcare Brotherhood of St Laurence Caroline Chisholm Catholic Care Co-Health DHHS - Child Protection Enhanced MCH Foundation House Good Shepherd Good Shepherd (child protection) IPC Health (ISIS) MacKillop Family Services MacKillop Family Services (child protection) MCH Micare (formerly New Hope Foundation) NDIS (National Disability Insurance Scheme) Noah's Ark - Early Intervention PSFO Royal Children's Hospital SCOPE - Early Intervention Specialist Children's Services - DET Spectrum VACCA VICSEG New Futures Western Health - Sunshine Hospital Yooralla West - Early Intervention Other

  Case Manager Name

  Phone

  Mobile

  
  

• Indigenous Status

  Does your child identify as Aboriginal or Torres Strait Islander?

  - Select - Aboriginal but not Torres Strait Islander Origin Both Aboriginal and Torres Strait Islander Origin Neither Aboriginal nor Torres Strait Islander Not stated/inadequately described Torres Strait Islander but not Aboriginal Origin

• Asylum Seeker/Refugee

  Are you an asylum seeker or refugee?
  Yes No

• Concession Cards/Visa Details

  Do you have a current/valid concession card/visa ?
  Yes No
  • Card/Visa type - Select - Health Benefit Card Pension Card DVA Gold, White Or Orange Card Temporary Protection/Humanitarian Visa Refugee & Special/Humanitarian Visa Asylum Seeker on Bridging Visa A to F Resolution of Status Visa
  • Card/Visa Number
  • Issue Date
  • Card/Visa Expiry

• Children with additional needs

  Does your child have additional needs?
  Yes No
  Details of additional needs

• Resident

  Are you a resident within Brimbank City Council?
  Yes No

• Maternal & Child Health Details

  3 1/2 year old consultation completed
  Yes No

• Additional comments to support your application

Each document supplied must be in JPG format and no larger than 5MB in size.

• Proof of Age:
• Proof of Concession Card:
• Proof of Residency:

• Privacy Statement

• The information collected through this form will be used by Brimbank City Council to allocate a kindergarten place for your child and for the purpose of communicating any and all associated early learning services to you. This information will be provided to Brimbank Kindergartens, Brimbank Staff, Contractors and any other relevant consultants, agents or affiliated parties where the information is required for the purpose outline. The data will be kept confidential and identifying information will not be disclosed for any purpose, unless required by law. Parents/guardians of enrolled children can access to seek correction of their information and that of the child upon request.
• I declare that I have read and understood the above procedure and agree for this application to be considered under these terms. I understand that the personal information provided on this application form is for Brimbank City Council Kindergarten Registration and will be shared by Council for the purpose of 3 & 4 year old Registrations. I acknowledge that I may apply to Council for access to or amend information contained on the application form.