SUSPENDED FORM

Eligible:

Kindergarten program you are applying for:

3 year old‎ 4 year old‎

Is this application for a second year of kindergarten? NB: Funding is usually only available for one year of 4YO program

Yes‎ No‎

Is your child currently attending 3 year old kindergarten?

Yes‎ No‎

Where:

Holy Trinity Kinder (HTK)‎ Other: ‎

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Child's Details:

Given name(s):

Last name:

Date of birth

Gender:

Male‎ Female‎

Address

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Parent/Guardian No. 1 Details:

Title

Mr‎ Mrs‎ Ms‎ Miss‎

Last name:

Given name:

Ph: (home)

Ph: (work)

Ph: (mobile)

Email:

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Parent/Guardian No. 2 Details:

Title

Mr‎ Mrs‎ Ms‎ Miss‎

Last name:

Given name:

Ph: (home)

Ph: (work)

Ph: (mobile)

Email:

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Selection Weighting Criteria:

Proximity to HTK – the child resides within a 5km radius of HTK or the child's parent/guardian works, studies, has a family member who assists with caring for the child or has a child at school or other childcare within a 5km radius of HTK

Not within 5km‎ Lives within 5km‎ Employment within 5km‎ Other: ‎

The 'No Jab, No Play' law is in effect and all parents/carers have to provide HTK with an Immunisation History Statement from Australian Immunisation Registry (AIR [Medicare]) for their child to attend our kinder.

My child

has an up to date immunisation history statement‎ is on an approved vaccine catch-up schedule‎ has a medical condition preventing them from being fully vaccinated‎ is eligible to enrol under the 'grace period' provisions‎ Other: ‎

Has a sibling attended HTK?

Yes‎ No‎

If yes, sibling name:

Is there a sibling applying to attend HTK at the same time in a different year group?

Yes‎ No‎

If yes, sibling name:

Is this child a multiple birth or a blended family child with a sibling attending the same year kindergarten at the same time?

Yes‎ No‎

If yes, sibling name:

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Additional Information:

Is your child in out-of-home-care or known to Child Protection?

Yes‎ No‎

Is your child as an Aboriginal and/or Torres Strait Islander?

Yes‎ No‎

Is your child an asylum seeker or refugee:

Yes‎ No‎

Does the family hold a current Health Care Card?

Yes‎ No‎

If yes, please provide expiry:

Does your child have any pre-existing medical condition, disability and/or additional needs?

Yes‎ No‎

If yes, please provide details:

I give permission for this information to be used to assist in the provision of services and will allow HTK to apply for necessary funding to assist my child.

Yes‎ No‎

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Timetable and Session Selection: 3 year old

3 year old. Please note this timetable is only a proposed timetable at this stage and will not be confirmed until enrolment numbers have been finalised. (Please click 'Next Page' if you are applying for 4 year old)

Two groups will be offered, Dolphin and Penguin of 4.5 hours each with parents also having the option to pay for an additional 4.5 hour session on the alternate day. 3 year old program sessions: Dolphin: Monday 8:30am-1:00pm (4.5 hours) Penguin: Thursday 8:30am-1:00pm (4.5 hours)

Please select:

Dolphin‎ Penguin‎ Both‎

Reason for selection:

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Timetable and Session Selection: 4 year old

4 year old. Please note this timetable is only a proposed timetable at this stage and will not be confirmed until enrolment numbers have been finalised. (Please click 'Next Page' if you are applying for 3 year old)

Children will be allocated to either the Seahorse or Turtle Group using your preferences and dependant on places available in each session. Each child will be allocated 15 hours of kinder each week (5 x 3hour sessions) plus on the days where they stay for both sessions on the one day (8.45pm–3.45pm) a lunchtime care program of 2 hours per week will occur, giving the children 17 hours at the kinder each week. A small fee applies for the lunchtime care program. 4 year old program sessions: Seahorse: Tuesday 8:45am-3:45pm & Friday 8:45am-11:45am (9hrs plus 1hr lunchtime care) Turtle: Monday 1:30pm-4:30pm & Wednesday 8:45am-3:45pm (9hrs plus 1hr lunchtime care)

Please select:

Seahorse‎ Turtle‎

In addition to the group selection, please also choose two additional 3 hour sessions from the following options: (Lunchtime care program is 11:45pm-12:45pm).

Seahorse options: (please choose two sessions)

Monday 1:30pm-4:30pm‎ Wednesday 8:45am-11:45am‎ Wednesday 12:45pm-3:45pm‎ Friday 12:45pm-3:45pm‎

Turtle options: (please choose two sessions)

Tuesday 8:45am-11:45am‎ Tuesday 12:45pm-3:45pm‎ Friday 8:45am-11:45am‎ Friday 12:45pm-3:45pm‎

Reason for selection:

There may be an opportunity to attend an additional session (totalling 3 full days). This is dependent on demand and will be offered where available. Please indicate your interest below.

Additional session:

Yes‎ No‎

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Declaration:

Offers will be sent out via email on 21st June 2019. To accept your place at HTK we will require a deposit of $150. This is non-refundable. NB: $50 non-refundable administration cost; $100 towards Term 1 fees, and will be forfeited if the offer is accepted and subsequently enrolment is cancelled. Failure to pay this will result in your child's place being forfeited unless an alternate arrangement has been made with the Committee. This must be paid in full. Enrolment forms will be emailed (with a link attached) in August and will require current documentation (birth certificate, Immunisation History Statement, Maternal Health Nurse 2YO or 3.5YO review, and applicable concession cards).

The information contained in this application for Holy Trinity Kindergarten Enrolment System is true and correct. I understand that deliberately providing false or misleading information may lead to my offer/place being revoked. I give Holy Trinity Kindergarten permission to verify information provided in relation to the weighting criteria and request evidence if deemed necessary.

I agree‎

If you have not received a confirmation of your application within two weeks of lodging your registration form, please contact the Admin Officer at HTKadmin@kindergarten.vic.gov.au or on 9598 8836.