APP ID:
Office Use Only
4 Year Old Full Day Funded Kindergarten
Enrolment Form
Please return to: City Of Kingston, PO Box 1000, Mentone, 3194
Telephone: 03 9581 4831 Fax: 03 9581 4500 Email: [email protected]
Parkdale and Edithvale Family and Children’s Centres
4 YEAR OLD FULL DAY CARE FUNDED KINDERGARTEN ENROLMENTS FOR 2015 ONLY
This is not a guarantee of enrolment.
th
To be eligible for 4 year old kindergarten children must be four years of age or older by 30 April in the year
they start kindergarten.
Children will need to attend for a minimum of 2 days per week to be eligible for this program.
To remain on the waiting list families must update personal information as required.
Date:
My child will be eligible to attend Funded Kindergarten in: ___________________ (year)
CHILD INFORMATION
(One application per child)
Child’s first name: __________________________
Child’s family name:
Child’s date of birth: _________________________
M 
_________________________
F 
Does this child have a sibling currently on the Centralised Wait List?
If yes, please provide details below:
Child’s Name/s: ______________________________________________________________________________
Child Care Centres Centralised Wait List 
4 Year Old Funded Kindergarten Wait List 
PARENT INFORMATION
Parent #1
Title:
Name:
Surname:
Address:
Postcode:
Home Phone:
Work Phone:
Mobile:
Email address:
Parent #2
Title:
Fax:
Name:
Surname:
Address:
Home Phone:
Email address:
Postcode:
Work Phone:
Mobile:
Fax:
Do you work or study in the City of Kingston?
Yes 
No 
Are you employed by the City of Kingston?
Yes 
No 
Is your child of Aboriginal or Torres Straight Islander descent?
Yes 
No 
Do you require an interpreter?
Yes 
No 
Parent #1. What is your first language?
Parent #2. What is your first language?
(Please note the above information is only a statistical collection and will not effect your place on our waiting list).
DAYS OF 4 YEAR OLD FUNDED KINDERGARTEN REQUIRED (tick applicable)
Monday 
Tuesday 
Wednesday 
Are these days flexible? Yes  No 
Thursday 
Friday 
Do you have any flexibility to start with less days? Yes  No 
How many days of care per week do you require? 2 or 3 or 4 or 5 (Please circle one number only)
Has your child attended a Funded Kindergarten program in the previous year?
Yes  No 
Is your child accessing a Funded Kindergarten program in another setting?
Yes  No 
REASON FOR CARE (tick all applicable)
Single Parent
Parent working / studying / training
Parent 1
Parent 2
Do you require an interpreter?
Yes 
No 
Yes 
Yes 
Yes 
No 
No 
No 
Parent seeking work
Yes 
No 
Does your child have a diagnosed disability, any food allergies or special requirements?
If yes, please give details:
Yes 
No 
KINDERGARTEN PREFERENCE FOR 2015 ONLY
If you choose more than one Kindergarten, please put in the order of your preference. The option to visit the
Edithvale Family & Children’s Centre and the Parkdale Family & Children’s Centre is not yet available.
Number in order
of Preference
____
Edithvale Family & Children’s Centre
122 Edithvale Road, Edithvale Vic 3196
Phone: TBA
____
Parkdale Family & Children’s Centre
122 Warren Road, Mordialloc Vic 3195
Phone: TBA
I acknowledge that all information supplied on this form is correct at the time of signing.
Signature:
_______________________________________
Date:
________________
Information provided for this form will be used for the purpose of allocating vacant child care places at a City of Kingston Child Care Service
Personal information collected by Council is used for municipal purposes as specified in the Local Government Act 1989. The personal information will be held securely and used solely by Council for
these purposes and/or directly related purposes. Council may disclose this information to other organisations if required or permitted by legislation. The applicant understands that the personal
information provided is for the above purpose and that he or 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. A full copy of our Privacy Policy may be obtained from the Kingston website: http://www.kingston.vic.gov.au or from one of our Customer Service Centres.
APP ID:
Office Use Only
4 Year Old Full Day Funded Kindergarten
Enrolment Form
Please return to: City Of Kingston, PO Box 1000, Mentone, 3194
Telephone: 03 9581 4831 Fax: 03 9581 4500 Email: [email protected]
Parkdale and Edithvale Family and Children’s Centres
4 YEAR OLD FULL DAY CARE FUNDED KINDERGARTEN ENROLMENTS FOR 2015 ONLY
This is not a guarantee of enrolment.
th
To be eligible for 4 year old kindergarten children must be four years of age or older by 30 April in the year
they start kindergarten.
Children will need to attend for a minimum of 2 days per week to be eligible for this program.
To remain on the waiting list families must update personal information as required.
Date:
My child will be eligible to attend Funded Kindergarten in: ___________________ (year)
CHILD INFORMATION
(One application per child)
Child’s first name: __________________________
Child’s family name:
Child’s date of birth: _________________________
M 
_________________________
F 
Does this child have a sibling currently on the Centralised Wait List?
If yes, please provide details below:
Child’s Name/s: ______________________________________________________________________________
Child Care Centres Centralised Wait List 
4 Year Old Funded Kindergarten Wait List 
PARENT INFORMATION
Parent #1
Title:
Name:
Surname:
Address:
Postcode:
Home Phone:
Work Phone:
Mobile:
Email address:
Parent #2
Title:
Fax:
Name:
Surname:
Address:
Home Phone:
Email address:
Postcode:
Work Phone:
Mobile:
Fax:
Do you work or study in the City of Kingston?
Yes 
No 
Are you employed by the City of Kingston?
Yes 
No 
Is your child of Aboriginal or Torres Straight Islander descent?
Yes 
No 
Do you require an interpreter?
Yes 
No 
Parent #1. What is your first language?
Parent #2. What is your first language?
(Please note the above information is only a statistical collection and will not effect your place on our waiting list).
DAYS OF 4 YEAR OLD FUNDED KINDERGARTEN REQUIRED (tick applicable)
Monday 
Tuesday 
Wednesday 
Are these days flexible? Yes  No 
Thursday 
Friday 
Do you have any flexibility to start with less days? Yes  No 
How many days of care per week do you require? 2 or 3 or 4 or 5 (Please circle one number only)
Has your child attended a Funded Kindergarten program in the previous year?
Yes  No 
Is your child accessing a Funded Kindergarten program in another setting?
Yes  No 
REASON FOR CARE (tick all applicable)
Single Parent
Parent working / studying / training
Parent 1
Parent 2
Do you require an interpreter?
Yes 
No 
Yes 
Yes 
Yes 
No 
No 
No 
Parent seeking work
Yes 
No 
Does your child have a diagnosed disability, any food allergies or special requirements?
If yes, please give details:
Yes 
No 
KINDERGARTEN PREFERENCE FOR 2015 ONLY
If you choose more than one Kindergarten, please put in the order of your preference. The option to visit the
Edithvale Family & Children’s Centre and the Parkdale Family & Children’s Centre is not yet available.
Number in order
of Preference
____
Edithvale Family & Children’s Centre
122 Edithvale Road, Edithvale Vic 3196
Phone: TBA
____
Parkdale Family & Children’s Centre
122 Warren Road, Mordialloc Vic 3195
Phone: TBA
I acknowledge that all information supplied on this form is correct at the time of signing.
Signature:
_______________________________________
Date:
________________
Information provided for this form will be used for the purpose of allocating vacant child care places at a City of Kingston Child Care Service
Personal information collected by Council is used for municipal purposes as specified in the Local Government Act 1989. The personal information will be held securely and used solely by Council for
these purposes and/or directly related purposes. Council may disclose this information to other organisations if required or permitted by legislation. The applicant understands that the personal
information provided is for the above purpose and that he or 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. A full copy of our Privacy Policy may be obtained from the Kingston website: http://www.kingston.vic.gov.au or from one of our Customer Service Centres.