CONFIDENTIAL

1Alison Rd Carrara, QLD 4211 Phone/Fax: 07 55941900

CARRARA TINY TOTS EARLY LEARNING CENTRE ENROLMENT FORM

Child’s Name: / Date of Birth:
Sex: / Male □ Female □ / Start Date:
Address: / Child CRN
Phone: / Age at Start Date: / Years Months
Religion: / Primary Language (spoken at home):
Is your child of Aboriginal or Torres Strait Islander origin: / Aboriginal: Yes □ No □
Torres Strait Islander: Yes □ No □

Attendance and Centrelink Information

Days of Attendance (please circle): / MON TUES WED THU FRI
CCB Percentage: / CCB Eligible Hours:
Do you have children attending another service? / Yes □ No □
If so, please provide details of the children and days of attendance:

Parent/Guardian 1

Parents Name: / Date of birth
Parents CRN
(centrelink registered) / Home Phone:
Mobile: / Work phone:
Religion: / Company name:
Home Address:
Work Address:
Email Address:

Parent/Guardian 2

Name: / Date of Birth:
Relationship to Child: / Home Phone:
Mobile: / Work Phone:
Religion: / Company Name:
Home Address:
Work Address:
Email Address

Other Children in the Family

Name: / Age: / Name: / Age:
Name: / Age: / Name: / Age:

Collection of Child/Emergency Contacts

In accordance with the law, we must have on file the name and telephone numbers of persons permitted to drop off and collect your child from the centre. If someone arrives to collection your child and we have not been notified in writing and their name is not listed, we cannot allow them to remove your child from the centre. No child will be released into the care of a person under the age of 18 years, unless authorised by Quality CCM. Court orders preventing the collection of children from the centre will only be enforced if a certified copy has been supplied to the centre.

Authorised Person /Emergency

(a)an authorisation, signed by a parent or a person named in the enrolment record as authorised to consent to the medical treatment of the child, for the approved provider, nominated supervisor or an educator to seek—

(i)medical treatment for the child from a registered medical practitioner, hospital or ambulance service; and

(ii)transportation of the child by an ambulance service; and

(b)if relevant, an authorisation given under regulation 102 for the education and care service to take the child on regular outings.

Authorised Person /Emergency 1 (Other than yourself)

Name: / Relationship to Child:
Home Address:
Home Phone: / Work Phone:
Email Address:
ID Type (e.g. License) / ID Number:
Signature of Authorised Person: / Authority to drop off/collect child? / Yes □ No□
Authorised to give permission of medical treatment to approved provider, nominated supervisor, or educator / Yes □ No□ / Authorised to seek permission of medical treatment from medical practitioner hospital or ambulance service / Yes □ No□
Authorised to allow transportation of the child by an ambulance service / Yes □ No□ / Authorised to allow childcare service to take child on regular outings / Yes □ No□

Authorised Person / Emergency 2(Other than yourself)

Name: / Relationship to Child:
Home Address:
Home Phone: / Work Phone:
Mobile: / Email:
ID Type (e.g. License) / ID Number:
Signature of Authorised Person: / Authority to drop off/collect child? / Yes □ No□
Authorised to give permission of medical treatment to approved provider, nominated supervisor, or educator / Yes □ No□ / Authorised to seek permission of medical treatment from medical practitioner hospital or ambulance service / Yes □ No□
Authorised to allow transportation of the child by an ambulance service / Yes □ No□ / Authorised to allow childcare service to take child on regular outings / Yes □ No□

Authorised Person / Emergency 3(Other than yourself)

Name: / Relationship to Child:
Address:
Home Phone: / Work Phone:
Mobile: / Email:
ID Type (e.g. License) / ID Number:
Signature of Authorised Person: / Authority to drop off/collect child? / Yes □ No□
Authorised to give permission of medical treatment to approved provider, nominated supervisor, or educator / Yes □ No□ / Authorised to seek permission of medical treatment from medical practitioner hospital or ambulance service / Yes □ No□
Authorised to allow transportation of the child by an ambulance service / Yes □ No□ / Authorised to allow childcare service to take child on regular outings / Yes □ No□

*Acknowledgment of Collection/Emergency Contacts*

Parent/Guardian Name (Printed):
Signature: / Date:
Witness Name (Printed): / Signature:

Medical /Nutritional Information & Requirements

Does your child have any allergies?
(please specify)
Does your child have any ongoing illnesses?
(please specify)
Does your child have any disabilities or other special needs?
(please specify)
Does your child have any specific nutritional requirements?
(please specify)
Does your child suffer from asthma?
If yes, please include a copy of your child’s Action Plan provided by your doctor
Is your child on regular medication?
(please specify)
Doctors Name: / Doctors Phone:
Doctors Address:
Dentists Name: / Dentists Phone:
Dentists Address:
Medicare Number: / Private Health Insurance: / Yes □ No □
Fund Name: / Member Number:
Type and Level of Cover:
Has your child been immunised? / Yes □ No □ / A copy of your child’s immunisation history is required. If your child is not immunised and an infectious outbreak occurs at the centre, your child will be required to remain at home until the exclusion period has passed.
Do you give consent for the Action Plan to be displayed at the centre? Yes □ No □
Do you give consent for the information contained within the Action Plan to be made available to both child care staff and emergency personnel? Yes □ No □

Court Order

Are there any court orders in place relating to your child? / Yes □ No □
If ‘Yes’, please provide a certified copy of the court order for the centre. Court orders cannot be enforced in the centre without this copy. All staff will be made aware of court order documentation.
Parent/Guardian Name (Printed):
Signature: / Date:
Witness Name (Printed): / Signature:

Updating InformationYes □ No □

☺ I understand that I am responsible for ensuring that the centre is advised if our circumstances change. I understand that the centre will provide me with access to the records the centre holds so that I may check the accuracy of the information. I understand I must provide the centre update immunisation information as I receive it.

Maintaining FeesYes □ No □

☺ I agree to the centre’s policy of maintaining my fees weekly. I also understand that fees are to be paid for every day that my child is booked in for. I understand I must pay for the booked days when my child is sick or absent and for public holidays and pupil free days. I understand that if my child’s fees fall 1 week in arrears, my child may lose their place/booking in the centre.

Permission and Agreements

I give the management/staff of the centre authority to:

☼Use the name and/or photograph of my child for centre displaysYes □ No□

☼Apply substances such as sunscreen, nappy change lotion, nappyYes □ No□

powder or other substances required onto my child’s skin (if needed)

☼To allow my child to be observed by students for developmental purposesYes □ No□

☼To remove my child from the centre in cases of emergencyYes □ No□

I agree/understand that:

☼I have read the centre’s policies and Parent Handbook and discussedYes □ No□

these with the Director as required. I agree to abide by the contents of

the policy and handbook information. I am also aware that the policies will

change from time to time due to review and I am invited to participate in

this process.

☼allow to check your child for head liceYes □ No□

☼In case of accident or illness requiring emergency treatment, every Yes □ No□

effort will be made to contact the parent/legal guardians and this listed

as emergency contact persons before treatment is sought. However,

if required I give permission for the staff of the centre to seek emergency

medical treatment for my child should this be considered necessary.

☼I hereby give permission for the staff of the centre to administer Yes □ No□

Panadol to my child should he/she have a fever and all other methods

to reduce my child’s temperature have failed. If I wish for my child to have

a different brand of paracetamol, then I will provide it to the centre, with

an appropriate chemists label attached. I understand that every effort

will be made to contact me, and any other contacts, at the time Panadol

needs to be administered and that I may be required to collect my

child immediately. If contact is unable to be made, then I agree that, for the

best interest and comfort of my child, Panadol may be administered, after we

have received medical advice from the/a practitioner.

☼I understand that Panadol, or an alternative brand, will only be Yes □ No□

administered once at the centre unless I have provided alternative

written instructions from a doctor. Should my child’s fever fail to

improve within 30 minutes of Panadol being administered, I understand

I must collect my child from the centre.

☼I understandIf there was an outbreak and your child(ren) are not immunised

they will be excluded; for their own safety, from the centre for the Yes □ No□

appropriate time frame.

☼ I agree to present my child(ren) immunisation details upon enrolment

and will keep them updated when changes occur; for the duration of their

stay at Carrara Tiny TotsYes □ No□

Observations

Due to privacy legislation, Carrara Tiny Tots Early Learning Centre requires parental/guardian permission to display children’s names and photographs within the centre. We also require the permission to take observations by means of audio and video tape recording.

Photographs with children’s names are only displayed within this centre and under no circumstances will photographs be given to other families if your child appears in them.

Audio and video tape recording may be used as a way of making accurate observations of your child’s development (for example language or motor development) and again would only be used within this centre.

I give permission for my child’s name to be displayed within the centre in the following ways (please tick):

□On their art work

□On sleeping/eating charts

□On birthday charts

□On lockers and locker charts

□Displayed with their photos

□Within the program and program evaluation

□On allergy/food restriction charts

□Within observations

I also consent to my child being the subject of observations for developmental assessments and

training purposes. This may include: video; photo and written observations of my child. I understand

that these observations are available for me to review on my request.

*Acknowledgment of All Permissions & Agreements*

Parent/Guardian Name (Printed):
Signature: / Date:
Directors Name (Printed): / BELINDA JOSEPH
Signature: / Date:

CHILD PROFILE

To assist us to get to know your child’s needs and interests, could you please complete the following questionnaire and return it with your enrolment forms.

Child’s Name: ______

Date of Birth: ______Start Date: ______

Parents/Guardians Names: ______

Days of Attendance (please circle): MON TUES WED THU FRI

Tell us a little about your family (examples: how many children, cultural background, things you enjoy to do as a family):______

______

______

______

Does your child have special needs? (Including any religious or cultural)

______

______

What is the primary language of the family? ______

Toileting Routine

Your child, Wears nappies□Is being toilet trained□

Needs reminding□Is independent at toileting□

Sleep Routine

Does your child sleep during the day?Yes □No □ Sometimes□

Does your child sleep with any special soft toys or objects? If yes, please provide details:

______

*Please include this item in their bag each day

Meal Routine

~ Does your child (please tick all that apply),

Need to be fed□Needs assistance□Eats independently□

~ Is your child? A fast eater□A slow eater□

A good eater□A fussy eater□

Will your child try new foods?Yes□No□

What are his/her favourite food/s? ______

Does he/she have any foods they dislike? ______

What interest/hobbies/toys does your child currently enjoy? ______

______

______

FAMILY ORIENTATION FEEDBACK FORM

Were you provided with the necessary information and support to assist your child to settle into the centre?
What did you like/dislike about your orientation?
Please provide suggestions for the improvement of the orientation process?
Any additional comments?

FAMILY PARTICIPATION FORM

Do you or your family have any skills, talents or interests that you would like to share with our centre?
Would you like to participate or assist in your child’s room with an experience for the children? EG. Cooking, playing an instrument or reading a story?
Do you have any suggestions for our programs?
Any other comments?

We actively encourage parents to visit and participate in the daily life of the centre, so please inform your child’s teacher if you would like to spend some time with us so that you can arrange a suitable date.

PARENT/GUARDIAN’S NAME: ......

SIGNATURE: ......

DATE:......

PARENT INPUT FORM

CENTRE PHILOSOPHY, BROAD GOALS AND PROGRAM

We are continually seeking family input in relation to our Centre Philosophy, Broad Goals and Weekly Program. Contributions to the Weekly Program will allow us as a team to extend on your child’s knowledge and skills and assist them in their learning journey.

Centre Philosophy and Broad Goal Feedback
What are some of your expectations regarding what your child will be learning?
Are there any areas of your child’s development that concern you or are there any self-help skills you would like your child’s teacher to concentrate on?
Does your child have any particular interests or favourite type of play that you would like us to incorporate into the program?

MENU SUGESTION AND FEEDBACK FORM

Your feedback, suggestions or recipe ideas are a valuable source of information for the continual improvement of our centre menu. We look forward to hearing from you.

COMMENTS/SUGGESTIONS:

PARENT NAME......

SIGNATURE:......

DATE:......

Code of conduct for parents and carers

As a parent/carer of a child involved in the service provided by Carrara Tiny Tots, I agree that:

I will respect the rights, dignity and worth of every person, regardless of their abilities, gender, religion or cultural background.

I will respect the decisions of employees and teach children to do likewise.

I will focus on and encourage children’s efforts and performance.

I will support all efforts to remove any form of abuse in this organisation and encourage a safe and supportive service environment.

I will remember that my child participates in activities for their own enjoyment, not mine.

I will raise any issues with management in order to promptly and efficiently rectify any concerns.

I will not treat any child or youngperson in an unfair, unjust, or discriminatory manner.

I will not smoke, drink alcohol, use illicit substances or use offensive language whilst on the premises.

If have any concerns or suggestions please do not hesitate to let us know…………………..

“I have read, understood, and will act in accordance with the above code of conduct.”

Name:………………………………………… Position:…………………………………….

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

Nominated Supervisor: Belinda Joseph Signature:……………………………………

Education and Care Services National Law 2011 Section

Education and Care Services National Regulations 2011

Regulation 168 (2) (f)

NQS Quality Area 4 Staffing Arrangement element 4.2

Queensland Government Blue Card Services – Child and Youth Risk Management Strategy Toolkit (p 11-16).

Created in conjunction with parents and caregivers

Created: March 2013

Revision date: March 2014

Revised November 2014

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