Individual Kinder Enrolment form - Eureka Community Kindergarten Association

Program details

Name of Preschool / Kindergarten*

Choose Program*

Please select one or multiple of the following options

1st year of kindergarten (3yo)

2nd year of kindergarten (4yo)

Early Start Kindergarten

1st year of kindergarten attendance (3yo)

2nd year of kindergarten attendance (4yo)

Early Start kindergarten attendance

Child Details

Child's Name*

First Last

Childs Date of Birth*

Child's Gender*

Male

Female

Child's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Child's Main Language Spoken at Home

Is your child identified as of Aboriginal or Torres Strait Islander descent?*

Yes

No

Does your child have refugee or asylum seeker status?*

Yes

No

Is your child a Health Care or Concession Card Holder*

Yes

No

Is your child in an Out of Home Care arrangement, including kinship care?*

Yes

No

Parent / Guardian 1 Details

Parent / Guardian 1 - Name*

First Last

Parent / Guardian 1 - Relationship to child*

Parent / Guardian 1 - Email*

Parent / Guardian 1 - Home Phone

Parent / Guardian 1 - Work Phone

Parent / Guardian 1 - Mobile Phone

Parent / Guardian 1 - Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent / Guardian 2 Details

Parent / Guardian 2 - Name

First Last

Parent / Guardian 2 - Relationship to child

Parent / Guardian 2 - Email

Parent / Guardian 2 - Work Phone

Parent / Guardian 2 - Home Phone

Parent / Guardian 2 - Mobile Phone

Parent / Guardian 2 - Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Information

Please provide any other helpful information about your child’s needs, (e.g.: Does your child have any severe allergies, does your child access speech therapy or other intervention services, or are there court orders relating to your child)

* Early Start Kindergarten (ESK)

Early Start Kindergarten provides free kindergarten to eligible three year old children.
To be eligible for Early Start Kindergarten your child must be aged three by 30 April in the year they will be attending a kindergarten program and:
• your child is Aboriginal and/or Torres Strait Islander, or
• your family has had contact with Child Protection (or been referred by them to Child FIRST).

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Individual Kindergarten Registration form

Program details

Child Details

Parent / Guardian 1 Details

Parent / Guardian 2 Details

* Early Start Kindergarten (ESK)