Preschool Field Officer consent form 1Introduction 2Kindergarten details3Child and family details 4Review Things you need to know Preschool Field Officers offer support, resourcing and practical advice to early childhood education and care services to foster children’s participation and inclusion in kindergarten. Kindergarten teachers require informed consent from parents/guardians to consult with a Preschool Field Officer about a child’s learning, development and family. Find out more on our Extra support for children at kindergarten page. After the form is submitted, we will: Email a copy of the completed form to the child’s primary parent/guardian/carer. Email a copy of the completed form to the kindergarten. Contact the child’s kindergarten service to discuss the request and coordinate Preschool Field Officer support. Kindergarten detailsKindergarten name * Required Kindergarten phone number * Required Kindergarten service email * RequiredProvide an email address to send a copy of this form to Kindergarten teacher * Required Given name Family name Kindergarten teacher email Kindergarten teacher non-contact day and times * RequiredPlease use the + icon to add additional days and times.DayTime <Please Select>MondayTuesdayWednesdayThursdayFriday Do you wish to add another teacher to consult with the Preschool Field Officer? * Required Yes No Kindergarten teacher Given name Family name Kindergarten teacher email Team leader or director Given name Family name Child detailsChild's name * Required Given name Family name Date of birth * RequiredPlease enter the date as displayed DD slash MM slash YYYY Country of birth * Required Gender * Required Female Male Self-describe Please specifyDoes the child identify as Aboriginal and /or Torres Strait Islander? * Required Yes-Aboriginal Yes-Torres Strait Islander Yes-Aboriginal and Torres Strait Islander No Has the child had their 3-and-a-half-year-old maternal child health check? * Required Yes No Unsure Is the child accessing the National Disability Insurance Scheme (NDIS)? * Required Yes No Unsure Kindergarten year * Required 3 year-old kindergarten 4 year-old kindergarten/Pre-prep Early Start kindergarten Child's days and times of attendance (fill as many as apply) * RequiredPlease use the + icon to add additional days and times.DayTime <Please Select>MondayTuesdayWednesdayThursdayFriday Family detailsName of parent/guardian/carer * Required Given name Family name Suburb of residence * Required Parent/guardian/carer phone number * RequiredParent/guardian/carer email * RequiredProvide an email address to send a copy of this form to Do you wish to add another parent/guardian/carer? * Required Yes No Details of additional parent/guardian/carerName of additional parent/guardian/carer Given name Family name Suburb of residence Additional parent/guardian/carer phone numberEmail Language spoken at home * Required Do you need an interpreter * Required Yes No Name of person completing this form * Required Given name Family name Relationship to child * Required Teacher Parent or legal guardian Other Please specify relationship * Required Consent * Required I have discussed this referral with the parent or legal guardian. I am satisfied they understand the proposed request to access the Preschool Field Officer program and I have their informed consent. Date of obtained consent * RequiredPlease enter the date as displayed Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920How was consent obtained? * Required Email Phone In person Review Please review the details below before you submit this form. If you need to go back to make changes, use the numbered steps at the top of this page or the ‘Previous’ button at the bottom of this page. If all the information is correct, please select ‘Submit’ to complete this form. {all_fields:exclude[103,114,163,191,233]}Your PrivacyWe use the information on this form to support a child’s learning, development and participation in their kindergarten program. The information may also be used to update Council’s customer databases to help carry out statutory functions and/or provide services. The personal information collected will be disclosed to the Victorian Government Department of Education, including through their electronic databases and reporting as required by the Preschool Field Officer program and will not otherwise be disclosed unless permitted or required by law. If the information is not collected, we will not be able to respond to or fulfil the submitted request. If you’d like to access or change the information shared, please email the Coordinator Governance at Boroondara@boroondara.vic.gov.au.PhoneThis field is for validation purposes and should be left unchanged.
