116 West Parade, Mt Lawley WA 6050

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Centre Director: Cimlie Bowden

Address: 116 West Parade, Mt Lawley WA 6050

Phone: 9227-9886
Fax: 9227-9694

Email:

Upon successful enrolment with Meela, a copy of your child’s birth certificate, immunisation and any other additional information such as allergy/ special dietary requirement details or anything that will help Meela educators take the very best possible care of your childrenare required along with your fully completed enrolment forms.

CHILD ENROLMENT FORM 2016

PLEASE NOTE$50.00 Enrolment Levy per family is applicable. This will be debited from your nominated authorised account by our direct debit system. If Enrolment is successful and a position offered for care, the amount of two weeks care period advance and the enrolment fee will be set for debit the Friday prior to commencement. Enrolment and requested days will be confirmed uponreceipt of payment from our ezidebit direct debit. To cancel an enrolment or booked day 4 weeks’ notice is required. Enrolment Application Date:______

CHILD’S INFORMATION

Child’s Surname: ______First Name: ______Middle Name: ______

Child’s Address: ______Post code: ______

Child’s CRN: ______Date of Birth: ______Place of Birth: ______

Gender: ______Cultural Background: ______Home Language: ______

Other Family members (siblings) Names/ Ages: ______

REASON FOR CARE

Meela CCC adheres to Government priority of access guidelines for more information please refer to our parent handbook

Working parents Seekingemployment Student Parentorchilddisability ChildatRisk Respite

DAYS / HOURS OF CARE Requested Commencement Date: ______

Office Approval / Monday  / Tuesday  / Wednesday  / Thursday  / Friday
Days Requested:

Room:Baby Room  Toddler Room  3 to 6 yr old Kindy Room 

(Please indicate care requirements for your child: i.e. 8-00am to 5-00pm, 7-30am to 3-15pm Office information used as guide only)

Orientation Visit Dates Requested: 1) ______2) ______3) ______

MEDICAL CONDITION: Special Dietary  Allergy  Anaphylaxis  Asthma  Other  ______

Please note further medical information may be required, please see office staff if your child has any of the above medical conditions.

Does your child have any known allergies? Please list details: ______

______

Does your child have a special need or dietary requirement? E.g. allergy, intolerance, religious custom requirement? ______

Is there any other relevant information you feel the centre needs to be aware of: ______

______

FAMILY DOCTOR:Doctor’s Name: ______Surgery Name: ______

Telephone No: ______Address: ______

Medicare Number: ______Ambulance Cover Number: ______

MEDICAL DETAILS:Previous Illnesses/Casualty/Hospitalisation: ______

Infectious Diseases: ______Other: ______

PARENT/GUARDIAN HOME INFORMATION

Parent/guardian One: Parent/guardian one must
be the person named as CCB or CCR applicant / Parent/Co-guardian Two:
Surname: / Surname:
First Name: / First Name:
Middle Name: / Middle Name:
CRN: / CRN:
Date of Birth: / Dat Date of Birth:
Gender: / Gender:
Address:
P/Code: / Address:
P/Code:
Home Phone: / Home Phone:
Mobile: / Mobile:
Home Email: / Home Email:
Occupation: / Occupation:
Work Phone: / Work Phone:
Work Email: / Work Email:
Country of Birth: / Country of Birth:
Language Spoken: / Language Spoken:
Email for accounts:
(please print clearly) / Email for accounts:
(please print clearly)

Details of arrangements of guardianship or custody and terms of any specific custody or access provision: Please provide any relevant court orders and supporting documentation if any______

NOMINATED EMERGENCY CONTACTS Must be completed and not be either parent/ guardian

NOMINATED EMERGENCY CONTACT 1. / NOMINATED EMERGENCY CONTACT 2.
Name: / Name:
Home Phone: / Home Phone:
Work Phone: / Work Phone:
Mobile: /
Mobile:
Relationship / Relationship
Address / Address
Signed by Contact: / Signed by Contact:

Please ensure that you have notified your above nominated emergency contacts regarding your intention to list them as your children’s emergency contact. After notification please have them sign the above acknowledgement showing nomination approval.

In an emergency I authorise the above people to be contacted and provide medical authority in the even I am unable to be contacted

Name: ______Signed: ______Date: ______

AUTHORISED PERSONS FOR COLLECTION DETAILS:Must be someone other than the child’s Parents/Guardian

I authorise the following people to come and collect my child from the centre:

Name: ______Signed: ______Date: ______

AUTHORISED CONTACT 1. / AUTHORISED CONTACT 2.
Name: / Name:
Home Phone: / Home Phone:
Work Phone: / Work Phone:
Mobile: /
Mobile:
Relationship: / Relationship
Address: / Address
Signed by Contact: / Signed by Contact:
AUTHORISED CONTACT 3. / AUTHORISED CONTACT 4.
Name: / Name:
Home Phone: / Home Phone:
Work Phone: / Work Phone:
Mobile: /
Mobile:
Relationship / Relationship
Address / Address
Signed by Contact: / Signed by Contact:

IMMUNISATION:

Please supply the Original Immunisation Records for your Child to Meela Office Staff. Immunisation Records will be photocopied and immediately returned. Children’s Immunisation records are available online (for children under seven) on the website: Other information: ______

If my child is not immunised I understand that he/she will be excluded from care during outbreaks of some infectious diseases.

NAME: ______SIGNED: ______DATED: ______

ACCIDENTS, ILLNESS AND EMERGENCIES:

1. We regret we are unable to care for sick children, or children with any contagious illness or symptoms. In the event of illness or symptoms displayedwith a possibility of contagion; Meela child care will not be able to provide care within the exclusion guidelines stated within the staying healthy in child care 5thEd. I have read and agree to Meela Child Care Centre’s Illness Policy and Guidelines.

Signed: ______Date: ______

In the event of an illness or accident we will contact parents/ guardians to inform of the situation and seek medical advice. In the event that we are unable to contact the parents or guardians:

1. I/ Weconsent to Meela child care centre obtaining medical treatment for my child from a hospital and understand that an ambulance will be sought to transport my child from the service to the hospital. I/ We understand that all costs involved in this will be incurred will be at our own expense and accept full responsibility.

Name: ______Signed: ______Date: ______

Service Provided Product and Applications Permissions

Meela Child Care Centre provides the following products for enrolled children. These items are supplied for in preparation of first aid, sun protection and hygiene. Meela Child Care is unable to isolate the brands due to availability. Please provide the following authorisations if you give permission for Meela to supply these to your children. If you do not wish for Meela child care to supply these products to your children or there are brands your child cannot use, please provide information regarding this. It may be requested depending on the nature of reason for you to provide an alternative brand suitable for your child.

ProductSupplied / Designed for Use with / Item Consent / Brands that children cannot use and why? / Parent/ Guardian Signature
Antiseptic Solution: / Minor Cuts
and abrasions / Yes  No 
Yes  No 
Sunscreen: / Sun
Protection / Yes  No 
Band-Aids: / Minor Cuts
and Abrasions / Yes  No 
Yes  No 
Dressing Tape: / Tape gauze
and Bandages / Yes  No 
Nappy Rash Cream: / Nappy Rash or Nappy Irritation / Yes  No 
Yes  No 
Edible Teething Aides:
I.e. Rusk sticks / Teething and
Sore Gums / Yes  No 
Insect Repellent: / Mosquito/ Bug
Repellent / Yes  No 
Hand Soap: / Hygiene / Yes  No 
Insect Sting Cream: / Insect Bites
And Stings / Yes  No 
Nappy Wipes: / Child Hygiene
And Care / Yes  No  Yes  No 
Nappies / Child Hygiene
And Care / Yes  No  Yes  No 

1. I acknowledge that in the event of product refusal, it becomes my responsibility to provide and maintain the supplies of the nominated substitute product listed above. Signed: ______Date: ______.
2. I understand all other medication require a signed Medication Authority Form. Signed: ______Date: ______.
3. I have read and agree to Meela Child Care’s Administration of Medication Policy.

Parent/Guardian: Signature: ______Date: ______

I verify that the above information provided is accurate and current to the best of my knowledge. I agree that if this information changes during my children’s enrolment period I will provide the updated information for reference to the service in writing as soon as possible. I understand that the service is governed by policy and procedure and that in the event of non-compliance and failure to comply with any warning or agreements put in place effectively may result in the cancellation of approved care. In addition to the completed enrolment for I have attached copies of my child’s immunisation history and birth certificate as requested by Regulatory and Family Assistance approval requirements.

Parent/Guardian: Signature: ______Date: ______

PERMISSIONS

I give permission for my child to participate in all activities offered in the education and care service. I acknowledge it is my responsibility to familiarise myself with the curriculum and to advise the centre in writing if I do not wish for my child to participate in a particular activity. Yes/ No

Parent’s Name______Signature______Date______

I give permission for my child to participate in environmental and community excursions by foot with educators within a 5km radius. Examples of locations visited may include but not limited to the Train Station, Local Park and the Library. Yes/ No

Parent’s Name______Signature______Date______

I give permission for my child to be observed by educators and visiting students for programming, planning and documenting purposes. Yes/ No

Parent’s Name______Signature______Date______

I give permission for my child to be photographed at the service for use only within the service. These photographs may be displayed around the service in learning displays and curriculums or any other purposes that the educators feel appropriate within confidentiality guidelines.I understand that these images and recordings will only be used for the purpose of my child’s observational records, curriculum planning as well as any additional documentation required by staff. I understand that occasionally Meela educators choose to use my child’s images in displays of learning with in the centre and DO / DO NOT give permission for. I understand all images taken will be handled confidentially and under no circumstances will any of the photos or visual images of my child leave the premises in anyone else’s possession without my consent. Yes/ No

Parent’s Name ______Signature______Date______

I give permission for my child to be Audio Recorded at the service for use only within the service. These recordings may be used as supporting learning evidence filed in your child’s file or any other purposes that the educators feel appropriate within confidentiality guidelines. Yes/ No

Parent’s Name ______Signature______Date______

I give permission for my child to be Visually Recorded at the service for use only within the service. These recordings may be used as supporting learning evidence filed in your child’s file or any other purposes that the educators feel appropriate within confidentiality guidelines. Yes/ No

Parent’s Name ______Signature______Date______

I give permission for my child to participate in checks by community health services who may visit the service offering health checks of attending children. Yes/ No

Parent’s Name ______Signature______Date______

PARENT STATEMENT AND AUTHORISATION

Please initial next to each item

1. I will, if required, produce evidence in support of this application, and I understand that I may be requested to present this information every six months. ______

1. I undertake to advise the Meela Child Care Centre of any change to the information within this form and also any special arrangements in relation to the care of my child. ______

1. I agree that Meela Child Care Centre will receive full payment of calculated fee accounts (Which include fees for public holidays & absences on booked days of care) within 7 days of issue, and if my child is absent for any reason I agree to notify the Centre. ______

1. I will notify Meela Child Care Centre in writing, should I want my child to be collected by any person other than those stated. ______

1. I hereby authorise the staff of the Meela Child Care Centre to care for my child, and I also give permission, in case of emergency or accident to call an Ambulance and/or a Medical Practitioner at my expense and further authorise that Medical Practitioner to carry out such treatment as he/she may consider necessary for my child. ______

1. I do/ do not give permission for my child being photographed for observation, documentation and display purposes within the Centre. (Separate permission is required for photographing my child for publicity and/ or promotions.) ______

1. I do/ do not give permission for my child to be observed by students for training purposes only______

1. On withdrawing my child from the Meela Child Care Centre I understand that required period for notification will be four weeks and will be required in writing. I understand that we will be required to pay for the 4 week notice period regardless of whether my child attends the Centre during the time of notice. ______

1. I am aware that the centre has a late collection penalty payment of one dollar a minute with a minimum of 5 minutes charge. ______

1. I am aware that the Centre is licenced by the Department of Communities and acts in accordance with the Child Care Service Regulations. A copy is available in the office for viewing ______

1. I do/ do not give permission for my child to receive support from a bilingual worker (PSCWA) if required____

1. I have read the Parent Handbook and agree to abide by centre rules and policies as outlined within. I understand the Centre rules and policies will be reviewed and updated as required and copies of all policies and procedures are available to me in the office for viewing. ______

1. I understand and accept that Meela Child Care utilises the direct debit system of Ezidebit as their only approved payment method. ______

1. I understand and accept that all Centrelink approved benefits are the responsibility of the family to arrange and support. Meela child care centre holds no responsibility over this. ______

Parent/Guardian’s Signature: ______Date: ______

Meela Child Care Centre Enrolment Application Form 2016

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PRIVACY STATEMENT

The Privacy Act 1988 as amended by the Privacy amendment (Private Sector) Act 2000 require that the following be brought to your attention. Before completing this form please read this information. Completion and lodgement of the form is taken as your acknowledgment and acceptance of this information provide

1. Meela Child Care Centre Inc. collects personal information including sensitive information about children and parents /guardians before and during the course of the child’s enrolment at the Centre. The primary purpose of collecting this information is to enable us to provide care for your child.

1. Some of the information we collect is to satisfy the legal obligations of Meela Child Care Centre Inc., particularly to enable the Centre to discharge its duty of care

1. Certain laws, governing or relating to the operation of the Meela Child Care Centre Inc. require that certain information be collected. These include Public Health and Child Protection Laws.
2. Health information about the child is sensitive information within the terms of the National Privacy Principles under the Privacy Act. We ask you to provide medical reports about children from time to time.

1. Meela Child Care Centre Inc. may need to disclose sensitive information to others regarding children attending the Centre, for administration and educational purposes. This information may include Government departments’ medical practitioners and people providing services to the Centre including resource agencies and specialists visiting.
2. If we do not receive the information referred to above we may not be able to continue the enrolment process of your child.

1. Parents may seek access to personal information collected about them and their child by contacting the Meela Child Care Centre Inc. There may be occasions when access is denied. Such occasions would include where access would have an unreasonable impact on the privacy of others, where access may result in a breach of the Meela Child Care Centre Inc. duty of care to the child, or where children have provided information in confidence.
2. The Centre engages in fundraising activities. Information received from you may be used to make an appeal to you. We may include your contact details in room lists. These would be in the emergency bag, or in your child’s individual file, your child’s dietary needs may be listed and on display in the rooms.

1. If you provide the Centre with the personal information of others, such as doctors and emergency contacts, we encourage you to inform them you are disclosing that information to the Centre and why. Advise them they can access that information if they wish upon arrangement and approval of the family although the centre does not usually disclose the information to third parties.

Parent/Guardian’s Signature: ______Date: ______

APPLICATION FOR MEMBERSHIP OF AN INCORPORATED ASSOCIATION

The Meela Child Care Centre Inc.

Annual Membership Form

2016/2017

I ______

(Insert APPLICANT’S name)

Address: 116 West Parade, Mount Lawley WA 6050
(Applicant’s address is required under section 27 of the Associations Incorporation Act (1987).

To protect the privacy of individual’s, the address inserted is

C/- Meela Child Care Centre Inc. 116 West Parade, Mount Lawley WA 6050.)

Apply to become a member of the above Association for 2016/2017

No membership Fee applies.

Members are eligible to nominate for the management committee & vote at the AGM

If my application is accepted, I agree to be bound by the rules of the Association.

Signature:…………………………………………… Date:……………………………………

Rule 5(1)(a) “Any parent or guardian who has legal guardianship of a child attending the Childcare Centre shall be entitled to become a member providing they agree to abide by the rules of the association.”

Rule 5(1)(b) “Any other person or family who are interested in the wellbeing of families, support the objects of the association and are acceptable to the Committee may apply in writing for membership provided they agree to abide by the rules of the association and pay a subscription fee that should be determined , from time to time, by the Committee. Such membership shall lapse on 31December each year.”

------Applicants to detach & keep ------

INFORMATION for APPLICANTS