City of Ballarat Kindergarten Application Form

Application Information

Application Type & Year

Application For *

Application Year *

Preferences

Preference options will be shown once you have selected your application type and application year

Child Details

Child's Given Name *

Child's Surname *

Child's Preferred Name *

Child's Date of Birth *

Male Female Other *

Is your child a twin/triplet/quad who is attending in the same year as their siblings? *

Yes No

Main language spoken at home? *

Does your child have a disability, developmental delay or complex medical needs? *

Yes No

We encourage you to attend your Maternal and Child Health Key Age and Stage consultations with your child.
Has your child had their 2-year-old and 3.5-year-old KAS visit (if relevant)? *

Yes No

Priority of Access

Answers to the following questions may mean that your child is eligible for free or subsidised Kindergarten

Do you or your child hold a current health care card, concession card, humanitarian/refugee or bridging visa? *

Yes No

Does your child identify as Aboriginal or Torres Strait Islander? *

Indigenous status *

Are you an Asylum Seeker or Refugee?

Yes No

Has your child had contact with ChildFirst or Child Protection? *

Yes No

Parent/Guardian 1 Details

Given Name *

Surname *

Street Address *

Suburb *

Postcode *

Home Phone

Business Phone

Mobile Phone *

Email Address *

Email Address Confirmation *

Relationship to child *

I would like to enter an additional parent/guardian

Parent/Guardian 2 Details

Given Name

Surname

Street Address

Suburb

Postcode

Home Phone

Business Phone

Mobile Phone *

Email Address

Relationship to child

How you found us?

How did you find out about the Central Kindergarten Registration scheme? *

Privacy Collection Statement

Your personal information is being collected by Ballarat City Council for the purposes of kindergarten allocation. Your information will be stored in the City of Ballarat's Customer Database and used to identify you when communicating with the City of Ballarat and for the delivery of services and information. For further information on how your personal information is handled, refer to the City of Ballarat's Privacy Policy at www.ballarat.vic.gov.au

I declare that all of the information which I have provided is true and correct and I consent to the use and discloser of the information provide to the City of Ballarat for the above mentioned purposes *

I acknowledge that as a result of the information which I have provided I may receive updates regarding other early year's services including but not limited to maternal child health, play groups and parent information sessions. *

Tick this box to register another child

Complete ALL fields before submitting