Please note: We cannot accept applications for unborn children
Country of Birth Adelie Land (France) Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Argentinian Antarctic Territory Armenia Aruba Australia Australian Antarctic Territoryt Australian External Territories Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Antarctic Territory Brunei Darussalam Bulgaria Burkina Faso Burma (Myanmar) Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile Chilean Antarctic Territory China (excludes SARs and Taiwan Province) Colombia Comoros Congo Congo, (Democratic Republic of) Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Falkland Island Fiji Finland France French Guinea French Polynesia Gabon Gambia Gaza Strip and West Bank Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong (SAR of China) Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyz Republic Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau (SAR of China) Macedonia (Former Yugoslav Republic) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Calendonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Africa Northern Ireland Northern Mariana Islands Norway Not Stated/Inadequately Described Oman Other,Not Elsewhere Classified Pakistan Palau Panama Papua New Guinea Paraguay Peru Phillipines Poland Polynesia (excludes Hawaii) Potugal Puerto Rico Qatar Queen Maud Land (Norway) Reunion Romania Ross Dependency (New Zealand) Russian Federation Rwanda Samoa Samoa,American San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South America Southern and East Africa Spain Sri Lanka St Helena St Kitts and Nevis St Lucia St Pierre and Miquelon St vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States of America Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (United States) Wales Wallis and Futuna Western Sahara Yemen Yugoslavia Zambia Zimbabwe
Language spoken at home? Afrikaans Albanian Alywarr Arabic (including Lebanese) Armenian Arrernte (Aranda) Assyrian (including Aramaic and Chaldean) Australian Indigenous Languages Bengali Bisaya Bosnian Bulgarian Burarra Burmese Cantonese Cebuano Chinese Croatian Czech Danish Eastern Asian Languages Eastern European Languages English Estonian Fijian Finnish French German Gilbertese Greek Gujarati Hakka Hebrew Hindi Hmong Hokkien Hungarian Indonesian Irish Italian Japanese Kannada Khmer Korean Kriol Kuurinji (Gurindji) Lao Latvian Lithuanian Macedonian Malay Maltese Mandarin Mauritian Creole Netherlandic Non Verbal (inc. Sign Language eg. Auslan Makaton) Northern European Languages Norwegian Not stated/inadequately described Other Languages Persian Pintupi Pitjantjatjara Polish Portuguese Punjabi Romanian Russian Samoan Serbian Sinhalese Slovak Slovene Somali Southeast Asian Languages Southern Asian Languages Southern European Languages Southwest Asian And North African Languages Spanish Swahili Swedish Tagalog (Filipino) Tamil Telugu Teochew Thai Timorese Tiwi Tongan Turkish Ukrainian Urdu Vietnamese Walmadjari Warlpiri Welsh Wik-Mungkan Yiddish
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Include 2nd Parent/Guardian details
Effective 1 January 2016 before enrolling a child into any early childhood service parent/guardians will need to ensure the child/ren are fully vaccinated for their age. Conscientious objection is no longer deemed an exemption under the No Jab, No Play legislation. Non-immunised children cannot be enrolled into Council's Early Learning Centres.
I declare the above information to be true and correct
The personal information requested is required primarily for the provision of the child care service referred to on this form and will only be shared with those directly responsible for providing that service. If you do not provide the information, we may not be able to deliver the service. If you would like to know more about privacy at Glen Eira City Council, including your right to seek access to any information collected on this form, please see Council’s privacy policy at www.gleneira.vic.gov.au or contact Council’s privacy officer on 03 9524 3333
I have read and understood the information privacy statement outlined above.
Tick this box if you would like to register another child after submitting this application