BRIGHT P-12 COLLEGE - Alpine Kids Club
ENROLMENT FORM
PH 0400 871 763
1. DETAILS OF PARENT/GUARDIAN(Account will be in this name)
Name…………………………………………......
Relationship to child......
Address…………………………………………......
…………………………………………………………………………………
Telephone
Home……………………………………………………………………….
Work………………………………………………………………………..
Mobile……………………………………………………………………...
Date of birth…………………………………………………………....
CRN......
Employer………………………………………………………………....
Languages spoken…………………………………………………….
Does the child live with this guardian? YES / NO
Postal address(please add if different from above)
......
......
Email address…………………………………………………………… / 2. DETAILS OF PARENT/GUARDIAN
Name…………………………………………......
Relationship to child......
Address…………………………………………......
…………………………………………………………………………………
Telephone
Home……………………………………………………………………….
Work………………………………………………………………………..
Mobile……………………………………………………………………...
Date of birth…………………………………………………………....
CRN......
Employer………………………………………………………………....
Languages spoken…………………………………………………….
Does the child live with this guardian? YES / NO
Postal address(please add if different from above)
......
......
Email address……………………………………………………………
PERSONS AUTHORISED TO COLLECT CHILD
Name/Relationship to child…………………………………………………………………………………......
Phone……………………………………Work ………………………………Mobile...... ………………………………..
Address………………………………………………………………………………………......
Name/Relationship to child…………………………………………………………………………………......
Phone……………………………………Work ………………………………Mobile...... ………………………………..
Address………………………………………………………………………………………......
Name/ Relationship to child…………………………………………………………………………………......
Phone……………………………………Work ………………………………Mobile...... ………………………………..
Address………………………………………………………………………………………......
EMERGENCY CONTACTS – Authorised Nominee
(An Authorised Nominee is a person who has been given permission by a guardian to collect the child from the education and care service and is able to give medical consent if the guardians are not contactable)
In the case whereby the guardians cannot be contacted and child is unable to remain at service due to illness trauma, disruptive behaviour or closure of service the Authorised Nominee will be contacted.
Name/Relationship to child………………………………………………………………………………………………………………………………..
Phone……………………………………Work ………………………………Mobile...... ………………………………..
Address………………………………………………………………………………………......
Name/Relationship to child………………………………………………………………………………………………………………………………..
Phone……………………………………Work ………………………………Mobile...... ………………………………..
Address………………………………………………………………………………………......
CHILD DETAILS
Full name…………………………………………………………………………………………………………………………………………………………….
Preferred name……………………………………………………………………………………………….. Gender…………………………………….
Home address.…………………………………………………………………………………………………………………………………………………....
Date of birth………………………………………………… CRN………………………………………………………………………………………………
School/teacher…………………………………………………………………………………………………………………………………………………….
Main language spoken………………………………………………… Other languages spoken……………………………………………….
Culture background……………………………………………………………………………………………………………………………………………..
CUSTODY DETAILS
Are there special access, custody arrangements or parenting plans?
YES / NO
If a court order exists please bring the original court order/s for the Coordinator to sight. Additionally, a copy must be attached to the enrolment form.
If these orders change in any way please notify Alpine Kids Club immediately. Additionally, a copy of the amended order must be attached to the enrolment form.
CHILD’S IMMUNISATION INFORMATION
Is your child fully immunised?
YES / NO
If YES, please attach your child’s Immunisation History Statement (this statement is easily found on the MyGov website).
If NO, please attach your child’s Conscientious Objection Form used for immunisation exemption.
CHILD’S HEALTH AND MEDICAL INFORMATION
Does your child have asthma?
YES / NO
Does your child have Epilepsy?
YES / NO / Does your child have Diabetes?
YES / NO
Does your child have any known allergies?
YES / NO
If your child does have known allergens, what are they?......
……………………………………………………………………………………………………………………………………………………………………......
Is your child at risk of anaphylaxis?
YES / NO
If yes, please state the triggers of your child’s anaphylactic reaction......
……………………………………………………………………………………………………………………………………………………………………...
If you answered YES to one or more of the above question you must provide relevant medical plans, signed by the medical practitioner treating your child. Additionally, you must provide relevant medications.
If these medical plans change in any way please notify Alpine Kids Club immediately. Additionally, a copy of the amended medical plans must be provided.
Does your child have any other medical conditions or special needs such as sensitivities or religious restrictions that are relevant to the care of your child?
YES / NO
If yes, please provide details......
……………………………………………………………………………………………………………………………………………………………………...
OTHER INFORMATION
Please provide any other information you feel the service should know about the child (likes, dislikes, fears, favourite activities, dietary restrictions, cultural information)
……………………………………………………………………………………………………………………………………………………………………......
……………………………………………………………………………………………………………………………………………………………………......
CHILDS DOCTOR
Doctors name………………………………………………………......
Contact number of doctor…………………………………………..
Address of doctor………………………………………………………. / Medicare number……………………………………………………….
Do you have private health insurance? YES / NO Do you have ambulance cover? YES / NO
Please note families will be responsible for fees associated with ambulance call out or any medical bills.
DECLARATION AND CONSENT TO EMERGENCY MEDICAL TREATMENT
I ……………………………………………………………………………………… (print full name/s) with lawful authority of the child
referred to in this enrolment form:
· Declare that the information in this enrolment form is true and correct.
· Agree to immediately inform Alpine Kids Club of any change to this information.
· Agree to abide by all policies and procedures of Alpine Kids Club.
· Consent to educators of Alpine Kids Club seeking medical treatment from a medical practitioner, hospital and/or an ambulance service.
· Consent to educators of Alpine Kids Club administering emergency medical treatment.
· Agree to collect or make arrangement for the collection of the child referred to in this enrolment form if requested to do so by the service.
SUNSCREEN CONSENT
I give permission for my child to have a 30+ sunscreen applied as per the service’s Sun Smart Policy.
YES / NO
If NO, I agree to provide sunscreen for my child.
PARENT/GUARDIAN SIGNATURE/S…………………………………………………………………………………………………………………
DATE……………………………………………………………………………………………………………………………………………………………….
PHOTOGRAPHIC CONSENT
I give permission for the child to be photographed and/or videotaped by educators employed by Alpine Kids Club. I understand that photos and/or footage may be used by the service:
· To create visual displays within Bright P-12 College.
· Within daily reflections
· Within individual and group observations
· For promotion material
PARENT/GUARDIAN SIGNATURE/S…………………………………………………………………………………………………………………
DATE……………………………………………………………………………………………………………………………………………………………….
MEDIA PERMISSION PERMISSION FORM
In keeping with current Privacy legislation requirements, Alpine Kids Club has deemed it necessary to update our Media Permission Form. Please consider granting all three permissions by ticking all three boxes. This form is valid for the entirety of your child’s time at Alpine Kids Club; however you may (of course) withdraw from one or all of the permissions at any time by contacting Alpine Kids Club on 0400 871 763.
At Alpine Kids Club we celebrate the efforts of our children by mentioning their participation and achievements in activities/excursions in the Bright P-12 College newsletter. Occasionally, photographs of children are included. By the signature below, I give consent for Alpine Kids Club to publish images of my child in the Bright P-12 College newsletter.
Photographs of children will appear on the Bright P-12 College website. These photographs will only ever be accompanied by children’s first names. If a full name is required, we will only publish this on the website with the additional consent from a parent/guardian. By the signature below, I give consent for Alpine Kids Club to publish images of my child on Bright P-12 College website.
We invite local press to Alpine Kids Club events and they are expected to follow the policies of Alpine Kids Club in relation to the publication of photographs of children. When a story is about an individual achievement we will always seek your consent before passing information or photographs to the press for publication. Children will only ever be identified by first name. By the signature below, I give specific consent for local press to publish images of my child. We have negotiated an agreement with the local press that student photographs will not be put on a newspaper website.
Parent/guardian name (please print)
……………………………………………………………………………………………………………………………………………………………………………
Parent/guardian signature
……………………………………………………………………………………………………………………………………………………………………………
TOWNSHIP EXCURSION PERMISSION FORM
This permission form is to allow children who attend Alpine Kids Club to participate in activities around the Bright Township ONLY. It is a blanket permission sheet that removes the need for parents/guardians to sign an individual permission form each time an activity takes place.
Activities covered by this permission form:
§ Educational activities around Bright CBD / § Bright Football Oval§ Bright Library / § Early Years Learning Centre
§ Bright Art Gallery / § Bright Ice Creamery
§ Bright Centenary Park, Howitt Park & Sommer Park (no water activities) / § Subway, Bright
§ Bright Museum & Rail Trail / § Bright Chocolate Factory
§ Bright Cemetery / § Cloud 9 Cinema, Bright
This form only covers activities listed; all other activities and excursions require an individual permission form.
Communication to parents/guardians –
Parents/guardians will be informed of activities covered under this permission form prior to the activity.
Supervision of children –
Any movement of a child will be with the supervision of a qualified educator.
TOWNSHIP EXCURSION PERMISSION FORM
I give permission for my child…………………………………………………………………..to attend activities as outlined in the Township Excursion Permission Form. I understand that I will have activities around Bright, communicated to me prior to the activity.
Parent/guardian signature: ………………………………………………………………………... Date: ………………………………….
PRIVACY NOTIFICATION
Alpine Kids Club uses the enrolment form to collect personal information for the purposes of service enrolment and statistical recording. The information may be shared with staff, funding agencies and administrators for operational purposes only. The information will not be disclosed to any other party except as required by law. You are able to amend or correct information on request, by contacting the service coordinator.
LAWFUL AUTHORITY - Parents
All parents have powers and responsibilities in relation to their children that can only be changed by a court order. The Children’s Services Regulations 2009 refer to these powers and responsibilities as “Lawful authority”. It is not affected by the relationship between the parents, such as whether or not they have lived together or are married. A court order, such as under the Family law Act, may take away the authority of a parent to do something, or may give it to another person.
LAWFUL AUTHORITY – Guardians
A guardian of a child also has lawful authority. A legal guardian is given lawful authority by a court order. The definition of “guardian” under the Children’s Service Act 1996 also covers situations where a child does not live with his or her parents and there are no court orders. In these cases, the guardian is the person the child lives with who has day-to day care and control of the child.
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