LMPA Kindergarten Registration

• At Risk/Vulnerable/Out of Home Care

• Is your child Known to the Department of Families, Fairness and Housing (DFFH)/Child Protection?
  Yes No
• Is your child in an Out of Home Care Arrangement including Kinship Care?
  Yes No

• Is your child Aboriginal and/or Torres Strait Islander Status

• Is your child identified as Aboriginal or Torres Strait Islander? Is your child Aboriginal and/or Torres Strait Islander Status Aboriginal but not Torres Strait Islander Origin Both Aboriginal and Torres Strait Islander Origin Neither Aboriginal nor Torres Strait Islander Not stated/inadequately described Torres Strait Islander but not Aboriginal Origin

• Asylum Seeker/Refugee

• Is your family an Asylum Seeker or Refugee?
  Yes No

• Early Start

• Is your child eligible for the Early Start Kindergarten (ESK) program?
  Yes No

• Family Services

• Does your child/family have a case manager / family support worker?
  Yes No
  Case Agency Anglicare Vic Family Care (Family Services) Anglicare Vic Family Care (Child Protection) Bendigo and District Aboriginal Services (BDAC) Child FIRST/Orange Door Department of Families, Fairness and Housing (DFFH) HAVEN Mallee Family Care (Family Services) Mildura and District Aboriginal Services (MDAS) Mallee Family Care (Child Protection)
  
  

  Phone

  Mobile

• Concession Cards

• Do you or your child hold a current Concession/Veteran Affairs Card or Protection/Asylum/Refugee Visa?
  Yes No
  • Card Type Health Benefit Card Pension Concession Card Department of Veterans Affairs Gold Card or White Card Refugee visa (subclass 200) In-country Special Humanitarian visa (subclass 201) Global Special Humanitarian visa (subclass 202) Emergency Rescue Visa (subclass 203) Woman at Risk Visa (subclass 204) Humanitarian Stay visa (subclass 449) Temporary Protection visa (subclass 785) Temporary (Humanitarian Concern) visa (subclass 786) Safe Haven Enterprise visa (subclass 790) Protection visa (subclass 866) A Bridging visa, and is in the process of applying for one of the above Refugee or Humanitarian visas. Current or expired ImmiCard

• Additional needs of the child

• Has your child been diagnosed with any additional needs or involved in/referred to any development support program?
  Yes No

• Medical needs of the child

• Does your child have any an medical conditions/allergies?
  Yes No

• Prior Connection

• Does your child have a prior connection to your 1st preference by the way of sibling in the past 3 years or attended 3 Year Old Kindergarten in the year prior?
  Yes No

• Maternal & Child Health Details

• Has the child had their 2 year old Maternal Child Health Key Age and Stage Visit?
  Yes No
• Has the child had their 3 1/2 year old Maternal Child Health Key Age and Stage Visit?
  Yes No
• Attended which Maternal & Child Health Centre:

• Immunisation Details

• Child Immunisation status Immunisation Status Certificate - Up to date Immunisation Status Certificate - Medical Exemption Grace Period - Catch Up Schedule Grace Period - No Catch Up Schedule Recognised Catch Up Schedule

• Court Orders

• Are there any court orders relating to your child?
  Yes No

• Additional comments to support your application

Each document supplied must be in JPG or PDF format and no larger than 2MB in size.

• Proof of Age:
• Proof of Immunisation:
• Proof of Concession Card:
• Priority Supporting Documentation - Court Order: