Boroondara Kindergarten Central Enrolment Scheme
Enrolment Application Form
MIT 781
Date Received Stamp:
Fee Receipt Info:
BKCES File No.
OFFICE
USE ONLY:
PARENTS/GUARDIANS RESPONSIBLE FOR ENROLMENT
Parent 1:
(Please circle)
Mr
Mrs
Ms Miss Dr Other
Given Name: _______________________________________________ Surname: ____________________________________
Address for Correspondence: ________________________________________________________ Postcode: ______________
Telephone: (H) __________________________ (M) ____________________________ (W) ____________________________
Email: _____________________________________________________ Relationship to child: ___________________________
Parent 2:
(Please circle)
Mr
Mrs
Ms Miss Dr Other
Given Name: _______________________________________________ Surname: ____________________________________
Address for Correspondence: (if different) ______________________________________________ Postcode: ______________
Telephone: (H) __________________________ (M) ____________________________ (W) ____________________________
CHILD DETAILS
Given Name: __________________________________
Date of Birth: ____/____/____
Surname: _____________________________________
Male
 Female 
Child’s Residential Address (if different): _______________________________________________ Postcode: ______________
Immunisation Status
 Fully Immunised for age
 Not immunised
KINDERGARTEN CHOICE AND YEAR OF ENTRY
How to fill in your preferences– please read Points to Consider When Completing your Enrolment Application Form.
Refer to the kindergarten session times. Complete preferences for your 3 and 4yo application separately. Number your selections in the
boxes provided beside each group. Start with number 1 for your most preferred kindergarten group. You may select up to 5
kindergartens and are required to consecutively preference all groups within the kindergarten. When selecting kindergartens with
extended hours, please indicate your choices where required.
Example of how the form should be filled out:
3 Year Old Kindergarten Year 20 __18_
1
BELLEVUE
Red
2
Yellow
3
BOROONDARA
Bilby
4
THE MERRELL
Echidna
5
DEEPDENE
Yellow
6
YONGALA
3 year old
BKCES Ph: 9278 4444
4 Year Old Kindergarten Year 20 __19_
1
BELLEVUE
Green
2
Blue
3
BOROONDARA
Platypus
4
Kookaburra
5
THE MERRELL
Koala
6
Wombat
7
DEEPDENE
Blue
8
Red
May 2017
1
3 Year Old Kindergarten Year
KINDERGARTEN
GROUP
ALFRED ROAD
Wombats
AUBURN SOUTH
Blue
20 _____
PREFERENCE
NUMBER
EXTENDED
HOURS (tick
if required)
Kookaburras
4 Year Old Kindergarten Year
Yellow
BELLEVUE
Note: Please contact The Craig Family Centre directly
for enrolment in their 3yo activity group
Red
KINDERGARTEN
GROUP
ALFRED ROAD
Koalas
AUBURN SOUTH
Green
Purple
Red
Yellow
BOROONDARA
Bilby
CAMBERWELL
BAPTIST
Koala
Tues 
Thurs 
Green
Thurs pm 
Yellow
Thurs pm 
CANTERBURY
AND DISTRICT
CANTERBURY
NORWOOD
CARA
ARMSTRONG
BELLEVUE
Wombat
CANTERBURY
AND DISTRICT
Blue
Orange
Red
Fri pm

Gold
ESTRELLA
Red
FORDHAM
AVENUE
Beetles
GLASS STREET
Gumnut
CANTERBURY
NORWOOD
CARA
ARMSTRONG
GLEN IRIS ROAD
Possums
DEEPDENE
HAWTHORN
EARLY YEARS
Penguin
Turtles
ESTRELLA
ROBERT
COCHRANE
Koalas
FORDHAM
AVENUE
Yellow
GLASS STREET
Possums
Beetles
GLEN IRIS ROAD
Crickets
Sunshine
STUDLEY PARK
Yellow
SUMMERHILL
Red
Thurs pm
Green
SURREY HILLS
Yellow
THE MERRELL
Echidnas
WEST HAWTHORN
Joeys
YONGALA
3 year old
Fri pm
Butterflies
Grasshopper
Mon pm
Green
Blue
Yellow
Dragonflies
Frogs
Bluebell
Kangaroo
Paw
Wattle
Koalas

HAWTHORN
EARLY YEARS
Dolphin 1
JJ McMAHON
MEMORIAL
Blue
NORTH KEW
4 year old
ROBERT
COCHRANE
4 year old
ROWEN STREET
Butterflies
Dragonflies
Ladybugs
ST PAULS
Dolphin 2
Red
Mon pm 
Tues pm 
Blue
Red
STUDLEY PARK
SUMMERHILL
BKCES Ph: 9278 4444

Lizards
Rainbow
ST PAULS

Platypus
DEEPDENE
ROWEN STREET
Mon
Kookaburra
Bumblebees
3 year old
Kookaburras
Green
CAMBERWELL
BAPTIST
NORTH KEW
EXTENDED
HOURS (tick if
required)
Mon  Tues 
Thurs 
BOROONDARA
Green
PREFERENCE
NUMBER
Blue
Caterpillars
JJ McMAHON
MEMORIAL
20 ____
May 2017
Blue
Blue
Yellow
SURREY HILLS
Blue
Purple
Red
THE CRAIG
4 year old
2

Red
Kangaroos
Koalas
THE MERRELL
Wombats
YONGALA
4 year old
Grey
Kangaroos
WEST HAWTHORN
OTHER DETAILS
Language Spoken at Home:_______________________
Multiple Birth
Twin
Koori Information:
 Triplets 
Aboriginal:
Yes 
No 
Torres Strait Islander: Yes  No 
Does your child have additional/special needs?
Yes  No 
If Yes, please state area of need: ___________________________________________________________________
Do both parents have parental responsibility? Yes 
No  If Yes, ensure you complete details for both parents above.
Are there any court orders relating to this child? Yes 
No  If Yes, please provide a copy of the relevant court documents.
Do you live within the City of Boroondara  If not, why are you requesting Kindergarten within the City of Boroondara?
______________________________________________________________________________________________________
Which, if any 3 year old kindergarten does the child attend? ______________________________________________
Has a sibling attended a BKCES kindergarten within the past five years? If yes, detail
Name: _____________________________ Year: _______ Kindergarten: __________________________________
For Auburn South, Estrella and Cara Armstrong Only: Current and past committee members state your name and the years
served ________________________________________________________________________________________
Repeat funding for 4 year old kindergarten – is your child applying for repeat funding? Yes

No 
If Yes, state which 4 year old kindergarten your child currently attends ______________________________________
Do you give permission for this information to be passed onto the Preschool Field Officer for planning purposes? Yes  No 
SPECIAL CIRCUMSTANCES
Please attach separate documentation to support any information in relation to the Enrolment Application.
APPLICATION FEES (GST Inclusive)
1 July 2015 to 30 June 2017
Please tick payment amount (for new applications only)
Application for 3 year old or 4 year old only
 $25.50
Health Care Card Holder  $12.75
Application for 3 year old and 4 year old
 $51
Health Care Card Holder  $25.50
Type of Concession: _______________________________ Expiry Date: ________________________
BKCES Ph: 9278 4444
May 2017
3
DECLARATION
I accept the terms of the Boroondara Kindergarten Central Enrolment Scheme (BKCES) selection criteria, and declare that the
information I have supplied is true and accurate. I understand that the personal information requested on the Enrolment
Application Form is being collected for the delivery of Council Services in accordance with Council’s powers, functions and
purposes under the Local Government Act 1989 and other relevant legislation. Council may disclose this information to
kindergarten committees in accordance with the Privacy Act 2000. I understand that I may apply to Council for access to
and/or amendment of the information by contacting the Boroondara Kindergarten Central Enrolment Scheme on 9278 4444. I
understand that in lodging an application, an offer of enrolment is not guaranteed.
Name ............................................................. Signature ............................................................ Date .........................
PAYMENT OPTIONS
Please tick:

CREDIT CARD Please complete the enclosed Credit Card and Cheque Payment Form and

CHEQUE

CASH
Lodge in person or by mail with your application. Cheques made payable to
City of Boroondara. Fax not accepted.
___________________________________________________________________________
Cash payment accepted in person only.
RC 106
All Enrolment Applications must be accompanied with payment of the appropriate Application Fee.
LODGING YOUR APPLICATION (on or after your child’s second birthday)
Mail
Boroondara Kindergarten Central Enrolment Scheme
City of Boroondara
Private Bag 1
Camberwell Victoria 3124
In Person
Email and Fax: Not accepted
Customer Services at:
Camberwell, 8 Inglesby Road
Hawthorn Arts Centre, 360 Burwood Road
Kew, corner Cotham Road and Civic Drive
KINDERGARTEN ENROLMENT CHECKLIST
Please complete this checklist before lodging your enrolment form
1. Has your child turned 2 years of age
If no, please lodge this enrolment on or after your child’s second birthday
Yes

No 
2. Have you advised your child’s immunisation status in the child’s detail section
Yes

No 
3. Have you nominated your child’s year of entry?
Yes

No 
4. Have you NUMBERED your preferences correctly?
Yes

No 
5. Have you signed and dated the declaration?
Yes

No 
6. Have you paid the correct application fee?
Yes

No 
BKCES Ph: 9278 4444
May 2017
4
Credit card and
cheque payment form
Return document to:
Mail - City of Boroondara, Private bag 1, Camberwell VIC 3124
OFFICE USE ONLY
Department:
Family Services
Payment for:
BKCES Enrolment Application
Reference:
RC Code 106
Narrative:
Kindergarten Central Enrolment
MIT:
______________
REC:___Infring or GL
RECEIPT: ___________
AMT PAID $__________
Child's Name:
Payment type:
Credit Card
Cheque (Payable to City of Boroondara)
PAYER: _____________
Cardholder name:
Mailing address:
Telephone number:
Credit Card details
Card type:
Visa
Mastercard
Amex
Credit card number:
/
/
Expiry date:
/
I,
Diners
/
, hereby authorise the City of Boroondara to charge the
(Cardholder’s full name. PLEASE PRINT CLEARLY)
Amount of $
GST Incl.(plus credit card surcharge) to my credit card for the purposes stated above.
Signature:
Date:
/
/
CREDIT CARD SURCHARGE: Payments made by Credit Card will incur a Credit Card Surcharge equivalent to the Merchant Service Fee imposed upon
Council by the Credit Card provider. The surcharge applicable to each card type is: Visa - 0.38%, Mastercard - 0.38%, Diners Club - 1.47%, AMEX 1.48%.
PRIVACY STATEMENT: The personal information requested on this form is being collected by Council for the purpose of charging fees in relation to the
above service. The personal information will be used by Council for that primary purpose or directly related purpose. The personal information collected
will be disclosed to Council's bank or other financial institution for the purpose of processing payments and will not otherwise be disclosed unless required
by law. If the information is not collected an alternative payment method will be required before your service request can be processed. The applicant
understands that the personal information provided is for the purpose of charging fees and that he/she may apply to Council for access to and/or
amendment of the information. Requests for access and /or correction should be made to Council’s Privacy Officer.
BKCES Ph: 9278 4444
May 2017
5