LMPA Kindergarten Registration

• At Risk/Vulnerable/Out of Home Care

• Is your child known to a Child Protection Agency or Child First?
  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 Department of Human Services Child FIRST Bendigo and District Aboriginal Services (BDAC) St Luke's Family Care (Child Protection) St Luke's Family Care (Family Services) HAVEN Off To An Early Start (OTAES/Enhanced Maternal Child Health) Other
  
  

  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 Card DVA Gold Card Temporary Protection/Humanitarian Visa Refugee & Special/Humanitarian Visa Asylum Seeker on Bridging Visa A to F Resolution of Status Visa

• 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: