Mansfield Kindergarten — 3-Year-Old Enrolment 2026

Fill out the form and upload requested documents. Submissions will be emailed to office@mansfieldkindergarten.com.au

Declaration

I (full name)

am enrolling my child (full name)

Date

Please attach copies of relevant documents below (birth certificate, immunisation statement, health plans etc.).

Birth Certificate (PDF/JPG/PNG)

Immunisation Statement

3½ year assessment

Information about the child

Given name(s)

Surname / Family name

Preferred name

Date of birth

Gender

Country of birth

Main language(s) spoken at home

Date arrived in Australia (if applicable)

Home address Postal address (if different)

Health Care Card (number)

Expiry date

Is the child of Aboriginal or Torres Strait Islander descent?

Relevant involvement (tick as applicable)

DHHS Involvement Child Protection Involvement (Past or Present) Child living in Out of Home Care (OOHC)

Information about the child's parents / guardians

Parent / Legal Guardian 1

Title Given name(s) Surname / family name Preferred name Does child live with this parent/guardian?

Parent / Legal Guardian 2

Title Given name(s) Surname / family name Preferred name Does child live with this parent/guardian?

Parent 1 - Date of birth Parent 1 - Gender Parent 1 - Relationship to child Parent 1 - Country of birth

Parent 1 - Address (if different) Home phone Work phone Mobile Email

Parent 2 - Address (if different) Home phone Work phone Mobile Email

Occupation (Parent 1) Occupation (Parent 2) Interpreter required? (P1) Interpreter required? (P2)

Other household members

Sibling 1 - Name

Sibling 1 - Age

Sibling 1 - Gender

Other household members / relationship

Additional contacts / authorisations (at least 2)

Contact 1 - Name Relationship to child

Contact 1 - Address Contact 1 - Home phone

Contact 1 - Work phone Contact 1 - Mobile

Contact 1 - Permissions (tick any that apply)

Collect the child Be notified in an emergency Consent to medical treatment Consent to ambulance transport Consent to sign records Authorise educator to take child outside premises

Contact 2 - Name Relationship to child

Contact 2 - Address Contact 2 - Home phone

Contact 2 - Work phone Contact 2 - Mobile

Contact 2 - Permissions

Collect the child Be notified in an emergency Consent to medical treatment

Court orders / parenting plans

Any court orders relating to powers, duties or access?

If yes, attach copy of court order

Child's immunisation information

Has your child been immunised?

Is immunisation up to date?

Upload Immunisation History Statement

Health & medical information

Child's doctor / medical practitioner

Medical centre / address

Phone number

Medicare number

Ambulance subscription?

Attach Asthma plan (if applicable)

Has your child been diagnosed as being at risk of anaphylaxis?

Allergies or sensitivities (describe)

Does your child have any other medical conditions / diagnosed healthcare needs?

Attach any Medical Management Plan / Risk Minimisation Plan

Dietary / cultural requirements & food tasting

Dietary restrictions?

Religious requirements?

Cultural requirements?

Has your child tried/eaten the following? (tick as appropriate)

Any reactions or dislikes?

Permission for food tasting / cooking activities?

Permissions

Sun protection - Educators to apply sunscreen?

Headlice checks permission?

Digital media (photos) permissions

Other information & general

Is there anything else we should know about the child?

Where did you hear about Mansfield Kindergarten?

Friends/Family Social Media Newspaper Previous family member attended Other (please specify)

Interested in committee position?

Declaration & signature

Parent/Guardian 1 name Parent/Guardian 1 signature (type full name as electronic signature) Parent/Guardian 1 date

Parent/Guardian 2 name Parent/Guardian 2 signature Parent/Guardian 2 date

After submission you will see a confirmation message. Please ensure uploaded documents are attached.