Child Care Manual

Enrolment Form for Sports HolidayClub2017

Belgravia Leisure Pty Ltd (“Company)

Belmont Oasis (“Centre”)

APPLICATION FOR ENROLMENT OF CHILD

Confidential and Subject to Approval by Supervisor

All sections must be completed before a child can be enrolled. Please notify us promptly of any changes.

Date: ____/____/____

CHILDS DETAILS:

Surname / Given Name / Date of birth / Age / Male/Female
1.
2.
3.
Address:

PARENT/GUARDIAN 1

Full Name: ______

Residential Address: ______

Work Address: ______

Phone: (work)______(home)______(mobile)______

Email Address______

LANGUAGE SPOKEN AT HOME

Is the language spoken at home other than English: - if so what language:

EMERGENCY CONTACT (Name of person who is authorised to collect and care for the child if the parent/guardianis unavailable to be contacted in the event of any accident, injury, trauma or illness of the child)

1.Full Name: ______(r/ship)______

Address: ______

Phone: (work)______(home)______(mobile)______

Phone: ______

Clinic Address:______

MEDICAL INFORMATION

Are there any medical or physical conditions from which your child/ren suffers that need to be brought to the attention of the Supervisor? Does your child have a disability? Do we need to pay attention to any particular need or behaviour? Please give details:

Please also detail- severity of conditions and treatments needed:

MUST BE COMPLETED / Child 1 / Child 2 / Child 3
Does your child have medical and/or behavioural issues?
If yes specify medical condition:
A medical form must be completed / Yes / No
______
______/ Yes / No
______
______/ Yes / No
______
______
Does your child self administer medication?e.g. for asthma
If yes specify medical condition:
A self administration form must be completed / Yes / No
______
______/ Yes / No
______
______/ Yes / No
______
______
Does your child have allergies?
If yes specify allergy:
Are they at risk of anaphylaxis?
A allergy or anaphylaxis action plan must be completed / Yes / No
______
Yes / No / Yes / No
______
Yes / No / Yes / No
______
Yes / No

We regret that we are unable to care for sick child or child with contagious illnesses.

PLEASE NOTE:All medication (self administered or assisted) must be given to staff.

CHILDS LIKES AND DISLIKES

Your child’s likes and dislikes are important to us. Please feel free to list any details about your child that will assist with our program and make your child’s stay with us a happy one.

______

CONDITIONS

By enrolling my child I agree to the following conditions:

I accept that I must in the centre while my child attends.
I understand I must return immediately to the club to attend to my child should I be requested to do so by club staff.
I consent to medical treatment being obtained for my child in an emergency.
Although every care will be taken, CentreStaff are free from all responsibility for accidents or loss of property in connection with any child’s participation.
The Centrereserves the right to excludechild from the Club for misbehaviour that is deemed inappropriate.

NOTE: in the event of suspension or expulsion from the Club, it is the parents’ responsibility to have the child collected immediately. No monies will be refunded for that session.

The Centrereserves the right to refuse any child or person entry to the Club.
I agree to pay all fees and/or charges in full.
I give permission for photo’s of my child/ren to be taken by Belmont Oasis Staff on holiday program for centre display purposes & advertising.
I warrant that the above mentioned participant is physically fit and mentally sound and able to engage in exercise and fitness programs at the Centre. I will inform management of any condition that may affect the ability to participate in any exercise or fitness program prior to commencement.
I understand that any payment to the program is nonrefundable and any payments for missed or absent sessions of the ‘student saver’ and the ‘student package’ payment options will be forfeited.

Please Tick which sessions you will be attending:

MONDAY
10th April / WEDNESDAY
12th April
9.15am-10.45am / 10.15am- 11.45am / 9.15am-10.45am / 10.15am- 11.45am
WEDNESDAY
19th April / FRIDAY
21st April
9.15am-10.45am / 10.15am- 11.45am / 9.15am-10.45am / 10.15am- 11.45am

*Please note, each session is $6 per child

Total Fee’s owing:______

DECLARATION

I declare that the information above is complete and accurate, and I have read, understood and agree to the conditions outlined above.I understand and agree that all times my child shall be at my own risk and I will not hold the Company, the centre or its staff liable for any personal injury which may result to my child or loss of property except for any liability by the Company if it fails to render its services with due care and skill or supplies any material in connection with those services which is not reasonably fit for the purpose for which they are supplied.

Parent sign: ______Date: ____/____/____

Print Name: ______