Application to Enrol - Kindergarten

Enrolment Form - Kindergarten
P.O. Box 630 Buninyong. 3357 Phone (03) 5341 - 8188

email: welcome@ballaratsteinerschool.com.au ABN 87 514 837 927
A parent or guardian who has lawful authority in relation to the child must complete this form. A brief explanation of lawful authority is found at the end of this form. The licensed children’s services or kindergarten must collect the child’s enrolment information in this form, as required by the Education and Care Services. National Law Act 2010(National Law), the Education and Care Services National Regulations 2011 (National Regulations) Please fill in all sections of this form. If a section is not relevant, please put a line through it. This enrolment form is for your child’s journey in Kindergarten and only one enrolment form is required for the two year program. It is assumed that all students enrolled in the Kindergarten program will attend for two years.
Student Information
Application Date *

DayMonthYear
Date
Date of Entry*

DayMonthYear
Date
Level of Entry to the Kindergarten:*
Child's Full Name*

First NameMiddle NameLast Name
Usually Called
Address *

Street Address

Postal Address

TownPostcode State

Post Code
Date of Birth*

DayMonthYear
Date
Gender*

Does the family have a heath Care Card?:*
Please provide a copy of your health care card to the front office.
Is the child of Aboriginal and / or Torres Strait Island descent?:*
What are the languages spoken at home? Primary and Secondary.
Information about the child’s parents (or guardians)

A parent includes a guardian of the child and a person with parental responsibility for the child under a decision or court order.
Primary Carer's Full Name*

First NameLast Name
Relationship to the child*
Address - (if different from the child)

Street Address

Postal Address

TownPostcode State

Post Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Secondary Carer's Full Name*

First NameLast Name
Relationship to the child*
Address - (if different from the child)

Street Address

Postal Address

TownPostcode State

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Siblings - Names Age School/Class/Playgroup*

Confidential
Are there any court orders, parenting orders or parenting plans relating to the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child? *
Please note: a parenting order means a parenting order within the meaning of section 64B(1) of the Family Law Act 1975 (Commonwealth). A parenting plan means a parenting plan with the meaning of section 63C(1) of the Family Law Act 1975 includes a registered parenting plan within the meaning of section 63C(6) of that Act.
If yes - please complete the following:
• Bring the original court order/s, parenting orders or parenting plans for staff to see and a copy must be attached to this enrolment form.
Court Order Documents

Cancelof
• Please note details of any court orders provided that relate to the child’s residence or the child’s contact with a parent or other person:

Staff will be required to photograph your child for their learning portfolio and records. Do you give permission for the kindergarten to publish photos of your child for publicity reasons? i.e. website, newsletter and / or promotional material.*

YesNo
Do you give permission for group photos containing your child to be shared with parents of other children who are also in that photo, for their learning portfolio?*

YesNo

Authorised Nominees to collect your child from kindergarten

Your consent is required for other people to collect your child from the kindergarten on your behalf. No adult can legally collect your child from kindergarten if they are not on this list. If you do not want to nominate anyone, please mark the first area with an X. This list may be changed throughout the year.
Name*

First NameLast Name
Mobile Number*
Relationship*
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Name

First NameLast Name
Mobile Number
Relationship
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Mobile Number
Relationship
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Authorised persons to be contacted in the event of an emergency and that the parents or guardians cannot be contacted.

These people become authorised nominees. Authorised nominee means a person who has been given permission by a parent or family member to collect the child from the kindergarten. (See section 170(5) of the Law). In the event that the child is not collected from the kindergarten, or in the case of illness, accident, injury, trauma or emergency when the parents or guardians cannot be contacted, this list will also be used to arrange for someone to collect your child. This list may be changed throughout the year. You can write as above if applicable. At least one contact must be listed, this area cannot be left blank.
Name*

First NameLast Name
Mobile Number*
Relationship*
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Name

First NameLast Name
Mobile Number
Relationship
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Name

First NameLast Name
Mobile Number
Relationship
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code

People other than parents or guardians who are authorised to give consent to medical treatment for your child or to authorise the administration of medication to your child.

There may be times when your child has an accident, injury, trauma or illness and consent must be given to medically treat the child and / or administer medication to the child. Please note that every attempt will be made to reach the parents or guardians first. If you do not want to nominate anyone, please mark with an X. You can write as above if applicable. This list may be changed throughout the year.
Name*

First NameLast Name
Relationship to child*
Mobile Number*
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Name

First NameLast Name
Relationship to child
Mobile Number
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Enrolment Form - Kindergarten