2025 Enrolment Expression of Interest Form

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If you would like to place your child on the expression of interest list for Alexandra & District Kindergarten, 15 Bayley street, Alexandra, VIC 3714- please complete the attached form.

Please note to be eligible for either the 3 or 4 yr old program, your child must turn three years old/four years old by April 30th in the year of attendance at kinder.

A copy of your child's birth certificate and immunisation history statement will be required on offer of enrolment.

EXPRESSIONS OF INTEREST CLOSE ON SEPTEMBER 6TH 2024

Please Note: We will contact families in October 2024 with place offers.

Should you have any questions please contact us on 5772 1387 or email alexandra.kin.admin@kindergarten.vic.gov.au

Email *

Child's Name* *

Child's Gender *

Male

Female

Unspecified

Child's Date of Birth *

YYYY

Child resides with?

Both Parents

Mum

Dad

Guardian

Permanent Care

Informal kinship arrangement

Formal kinship arrangement

Foster care

Other:

Clear selection

Which program are you registering your child's interest for? * If you are unsure which program to start your child in please don't hesitate to call us on 5772 1387 to discuss. *

Pre- kinder ( 3 yr old kindergarten)

Kindergarten (4 yr old kindergarten)

DEPARTMENT OF EDUCATION AND TRAINING PRIORITY OF ACCESS CRITERIA- please tick if your child meets any of these criteria

Children at risk of abuse or neglect (referred to by child protection child first, MCH or family services), including children in Out-of-Home Care (or children who have accessed Early Start Kindergarten or Access to Early Learning)

Aboriginal and/or Torres Strait Islander children

Asylum seeker and refugee children

Children eligible for the Kindergarten Fee Subsidy (A child or parent holds a Commonwealth Health Care Card, Pensioner Concession Card, Veteran’s Affairs Card or is a multiple birth children (triplets, quadruplets)

Children with additional needs, defined as children who: is assessed as having delays in two or more areas and is declared eligible for a second funded year of kindergarten (Child holds a Child Disability Health Care Card, has previously been approved for Kindergarten Inclusion Support Package, or referred by: the National Disability Insurance Scheme, Early Childhood Intervention Service Preschool Field Officer, or Maternal and Child Health nurse)

Parent/ Guardian Full name *

Relationship to Child *

Parent

Guardian

Carer

Grandparent

Address *

Phone Number *

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

Yes

Second Parent/Carer details- Include name, phone number and address if different to child's

Language Spoken at home (if not english) *

Immunisation

The Government’s No Jab No Play laws require all children to be age-appropriately immunised before enrolment can be confirmed. Further information on immunisation requirements for enrolment in early childhood services is available on the State Government's Better Health Channel at https://www.betterhealth.vic.gov.au/campaigns/no-jab-no-play

Are your child's immunisations up -to- date *

Yes

Special Needs

Is your child registered with a specific service/agency? ie Paediatrician, Speech Pathologist, Child First *

Yes

Please indicate if you hold any of the following:

A Commonwealth Health care card

A Commonwealth Pensioner concession card

Department of Veterans' affairs Gold or White Card

Refugee Visa (subclass 200)

Protection Visa (subclass 866)

Emergency Rescue Visa (subclass 203)

Bridging Visa A-E

Any additional information that is relevant to your child's expression of interest-

Thank you for completing this form. Families will be notified when enrolment places are offered. (Enrolments are confirmed around Sept/Oct).

A copy of your responses will be emailed to the address you provided.

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