OSHC Enrolment Information
Dear Families
Welcome to the Henbury School Out of School Hours Care program (OSHC) Holiday Program.
Fees: $30 per day casual bookings or 5% discount fulltime bookings $140 per week.
We are Child Care Benefit approved (CCB) so please provide Centrelink Registration Numbers (CRN) and a copy of Family Assessment letter for proof of approval.
Please take some time to read through the attached paperwork, and familiarize yourself with our policies and procedures.
Any queries or concerns please contact or come and visit me either on school premises, by email or on 8927 5088.
I look forward to working with you to provide a positive family orientated environment for all involved with the OSHC program.
Karen Shearer
OSHC Coordinator
July 2011
Conditions of Enrolment
1. Enrolment and indemnity must be completed before any child is accepted into the centre.
2. Details of any problems, disabilities or family circumstances that may affect the child are included on the enrolment.
3. Children must be signed in on the roll by a staff member in the afternoon and signed out by a parent upon collection in the afternoon.
4. Access of the child will only be given to persons nominated on the enrolment form. Prior notice in writing or by verbal communication directly to the coordinator is required if another person is collecting the child. This person must be over the age of eighteen years.
5. Please notify the centre of any changes concerning enrolment details immediately.
6. If your child is unable to attend on a booked day please notify centre as soon as possible. No credit will be given for cancellations less than 7 days notice.
7. Fees must be paid one week in advance. Cheques are made payable to Henbury.
8. Children must be collected no later than 5.30pm or a fee of $10 for the first 10 minutes or part there of and $1.00 per minute thereafter, will be charged for each child collected after 6pm.
9. I understand that if my child’s temperature rises above 37.5 degrees, every attempt will be made to contact emergency contact person. If no contact is made, staff may administer one dose of paracetamol in accordance with the instruction on the bottle.
10. In the event of an emergency, I authorise staff to obtain an ambulance, medical or hospital assistance, as it deemed necessary for the welfare of my child. I acknowledge that I will bare all the cost of this assistance if every reasonable effort is made to contact me, my partner or emergency contact person has been unsuccessful, and I authorise a doctor to administer any immediate medication, anesthetic or minor surgery necessary.
11. I understand that I am to comply with the Department of Health regulations in relation to immunisation. If my child is not immunized and an outbreak of an infectious disease occurs, I understand that I am required to exclude him/her from the program for the duration of the outbreak.
Signed: ______Date: ______
Enrollment Family and Contact details
Child’s name ………………………………………………………
Date of birth ………………………………………………………
CRN ………………………………………………………
Has your child been assessed by FRO? YES / NO
Address ………………………………………………………
…………………… Post code……………………..
Language spoken @home ……………………Religion……………………….
1st Guardian name ………………………………………………………
Relationship to child ………………………………………………………
CRN ………………………………………………………
Date of Birth ………………………………………………………
Address ………………………………………………………
………………………………………………………
Phone Number …………………….mobile………………......
Place of Employment/ Occupation ………………………………………………………
Business Phone Number ………………………………………………………
2nd Guardian name ………………………………………………………
Relationship to child ………………………………………………………
CRN ………………………………………………………
Date of Birth ………………………………………………………
Address ………………………………………………………
………………………………………………………
Phone Number …………………….mobile………………......
Place of Employment/ Occupation ………………………………………………………
Business Phone Number ………………………………………………………
Custodial Parent/Caregiver (if applicable)………………………………………………
Access of other parent …………………………………………… Yes/No
NB: Please attach copy of Family Court Order of Injunction detailing access arrangement
Emergency Contacts and Authorisation
I authorise Henbury Outside School Hours Care staff to contact the persons listed below to;
1. Collect my child from the centre
2. Make decisions on the welfare of the child if the legal guardian is not contactable.
Contact No1.
Name ………………………………………………………………………
Address ………………………………………………………………………
………………………………………………………………………
Phone Number …………………………….mobile………………………………...
Relationship to child ………………………………………………………………………
Contact No2.
Name ………………………………………………………………………
Address ………………………………………………………………………
………………………………………………………………………
Phone Number …………………………….mobile………………………………...
Relationship to child ………………………………………………………………………
Contact No3.
Name ………………………………………………………………………
Address ………………………………………………………………………
………………………………………………………………………
Phone Number …………………………….mobile………………………………...
Relationship to child ………………………………………………………………………
I hereby authorise staff of Henbury Outside School Hours Care centre to refuse access to the following people unless legal documentation has been supplied to the centre.
Name ………………………………………………………………………
Relationship to child ………………………………………………………………………
Name ………………………………………………………………………
Relationship to child ………………………………………………………………………
Authorisation Signature ………………………………………………………………
Date ……………………………… witness by…………………………..
The following named people have permission to pick up my child from OSHC
1)
Name ………………………………………………………………………
Phone Number …………………………….mobile………………………………...
2)
Name ………………………………………………………………………
Phone Number …………………………….mobile………………………………...
3)
Name ………………………………………………………………………
Phone Number …………………………….mobile………………………………...
4)
Name ………………………………………………………………………
Phone Number …………………………….mobile………………………………...
Applicant’s Declaration and Indemnity Form
I have read the conditions of enrolment and agree to abide by them in every respect. I acknowledge that my child will be exposed to all normal risks that may be associated with the Henbury Outside School Hours Care Program.
In consideration of Henbury Outside School Hours Care Program I admit my child.
Child’s Name ………………………………………………………………………
To the Henbury Holiday Program
I Hereby agree that I will indemnify Henbury School Outside Hours Care Centre, their officers and agents and keep them indemnified against claims, demands actions and Liabilities of any kind (other than due to willful negligence) in the course of my child’s participation in the program.
I authorise Henbury School Hours Care Centre, their officers staff, employees or agents in the event of any injury or illness, to obtain such ambulance, Medical and hospital assistance as required, and agree to meet any and all expenses thereby incurred.
Signature of Parent/Guardian ………………………………………………………
Date ………………………………………………………
Witness by ……………………………………………………....
Date ………………………………………………………
Child’s Medical Information
Child’s Doctor ………………………………………………………………
Address ………………………………………………………………
………………………………………………………………
Phone Number ………………………………………………………………
Immunisation Status
Date of last Tetanus injection ……………………………………………………………..
Photocopy of Immunisation Yes/No
Diagnosis/Condition ………………………………………………………………
Does your child suffer from?
Asthma Yes/No
Epilepsy Yes/No
Allergies Yes/No
Does your child have regular medication Yes/No
If yes please request a Medication Form.
Any other details in relation to your child’s medical needs.
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
Eating and Dietary requirements
Likes ………………………………………………………………………………
Dislikes ………………………………………………………………………………
Food Allergies ……………………………………………………………………………...
Special Information
Does your child have any fears (eg dark noise etc)
If yes please Specify ………………………………………………………………………
Have there been any changes in the family recently (eg birth, death or divorce) Yes/No
Please Specify ………………………………………………………………………
Does your child have any special hobbies/ interests Yes/No
If yes please Specify ………………………………………………………………………
Does your child use sign language or any other forms of communications? Yes/No
If yes please Specify ………………………………………………………………………
Is there any particular communications program you would like to use at the program (eg behaviour management or Compic. Yes/No
If yes please attach a copy of the program.
Do you give permission to access educational information from Henbury school? Yes/No
Photographic Permission
1. Photographs and videos to be taken during the programs at OSHC? Yes/No
2. Photographs to be used in OSHC and Henbury School Newsletter? Yes/No
3. Photographs to be used in newspapers to promote Henbury School? Yes/No
4. Photographs to be used in the community to promote Henbury School and OSHC? Yes/No
I Parent/Guardian ……………………………………………………………………
Give permission for my child ……………………………………………………………
photographs to be used in the above settings of Henbury and OSHC programs.
Signature of Parent/Guardian ……………………………………………………………
Date ……………………………………………………………………
Witness By ……………………………………………………………………
Date ……………………………………………………………………
Student Medical Request
Unlabelled drugs will not be administered.
I……………………………….parent/guardian of student ………………………………..
Request Henbury School to administer the following drugs:
Drug information
Name:………………………………………dose………….. time………………am/pm
Name:………………………………………dose…………...time………………am/pm
Name……………………………………….dose……………time………………am/pm
As per prescribed by Dr………………………………………………………………….
For the purpose of treating the medication condition ……………………………………
And I give permission for the school’s registered nurse to contact the Doctor if necessary.
Please describe the positive actions of the medication:……………………………………
………………………………………………………………………………………………
Please describe the adverse reactions of the medication:…………………………………..
………………………………………………………………………………………………
Parent/Guardian signature: ………………………………………….Date………………...