LUCAS HEIGHTS VACATION CARE ENROLMENT FORM SEPTEMBER/OCTOBER 2017
Name of Parent Claiming CCB:Child/ren’s name/s:
Have you used Sutherland Shire Council’s Vacation Care before? / Yes / No
TERMS & CONDITIONS
Fee Payments
§ In applying for enrolment, I hereby acknowledge that I am wholly responsible for all fees payable to Sutherland Shire Council, in respect to my child/ren being in care.
§ I understand that any fees paid are not refundable or transferable.
§ I am aware that bookings are subject to availability and the early bird rate will not apply after the enrolment closing date. Please Refer to the current Schedule of Fees & Charges on the Council’s Website.
§ I am aware that I am required to complete either my credit card details or direct debit details on the attached form.
§ I am aware that I am liable to pay for the days and excursions requested on this form (subject to availability) and I cannot cancel or request an exchange of days.
§ I am aware that I can add days and make payment at that time
Child Care Benefit & Child Care Rebate
§ Any request for a CCB backdate can only be done up to 30 days from the end of the Vacation Care period.
§ I understand that I am responsible for registering for Child Care Benefit and Child Care Rebate.
§ I acknowledge that if there is no Child Care Benefit or Child Care Rebate approval at the time of my booking I am liable to pay full fees.
Injury or Loss to Person or Personal Property
§ I understand that whilst every care and precaution will be taken, Sutherland Council and its staff are not responsible for any injury, damage or loss to my child or their possessions whilst at the Centre or on an excursion.
Privacy And Storage Of Information
The personal information that Council is collecting from you is for the purposes of the Privacy and Personal Information Protection Act 1998 (“the Act”).
The information you have supplied will be stored at Council while your child is attending care and electronically for Child Care Benefit purposes. This information will then be stored in Council archives for up to 7 years.
The intended recipients of the personal information are:
§ Authorised Officers within Sutherland Shire Council
§ A person otherwise authorised by law to inspect the records.
Council is collecting this information for the purpose of maintaining accurate child-care information and parental contact details. In addition, Council may use this information for time to time in order to contact you to inform you of updated children’s services information.
OFFICE USE ONLY
File Name: / Entered By:
Family Code: / F0 / Date Entered:
Receipt: / Journal:
TERMS & CONDITIONS CONTINUED
Booking Conditions
§ Payment will be processed or charged by close of business the day your booking is received
§ Attendance will be refused if parent arrives at service without making payment prior
§ Bookings received after the closing date will be charged the daily fee rate
§ If your enrolment form is not completed your booking will not be processed until a completed enrolment form is received.
§ The enrolment/booking form for the current vacation care period must be completed. Copies of previous forms will not be accepted
§ Booking will not be accepted after 10:00am the day before care
Information For Parents If Your Child Does Not Attend Care On The Scheduled Start Date
Families who give notice of their intention to not start care on the agreed date need to be aware of the following information provided in the Child Care Service Handbook 2014, Section 13. In particular we draw your attention to the area of Child Care Benefit (CCB) and Child Care Rebate (CCR) which may not be payable to families. The following is an extract from the abovementioned Handbook containing information that is relevant to this service:
“A child who has not yet received care …
CCB will not be paid for absences where fees are charged to reserve a place for a child who has not yet started education and care. CCB will not be paid for absences once a child has ceased education and care.
However, if a child is booked in to start at your service on a particular date, and does not start on that day the family may only receive CCB for the days the child was expected to attend if the child's 42 days absences have been exhausted and the absence is an additional absence. Initial 42 days absences may not be claimed for these days".
Please be aware that Sutherland Shire Council observes the above practice and that in the event your child does not start care on the booked date, CCB is not payable on the outstanding amount.
If you require further clarification of this, please call the Customer Service Team on 9710 0466.
Excursions & Transport
§ I understand that excursions may be cancelled due to low numbers and I will be credited back the excursion cost
§ I understand that due to numbers and staffing my child may be transported to and from another centre if they are not attending an excursion, and I will be notified of this at the centre.
Has your child been immunised in accordance with Department of health guidelines?
Please supply an updated immunisation statement if your child falls into one of the following categories:
§ Child is new to the service
§ Child has been immunised since last supplied immunisation statement
I have agreed to enrol my child/ren
in the Sutherland Council Vacation Care Program. / (Names of children)
I have read the agree to the abovementioned Terms and Conditions
Print Name: / Date:
Email Address: / Relationship to child/ren:
You must complete all the sections below:
Relationship to Child/ren
First Name / Surname
Home Phone No / Work Phone No
Mobile Phone No / Date of Birth
Address
Occupation
Country of Birth
Parent’s CRN
PARENT / GUARDIAN 2
Relationship to Child/ren
First Name / Surname
Home Phone No / Work Phone No
Mobile Phone No / Date of Birth
Address
Occupation
Country of Birth
Medicare Number:
EMERGENCY CONTACTS - If parents unavailable
Emergency Contact / Contact 1 / Contact 2
First Name
Surname
Home Phone No
Work Phone No
Mobile Phone No
Relationship To Child
Please tick which permissions you give each contact person
To collect child/ren / To collect child/ren
To authorise medication for child / To authorise medication for child
To authorise excursions for child / To authorise excursions for child
CULTURAL BACKGROUND
What is the primary language used in your child/ren’s home?
What is the cultural background of your child/ren?
What is the cultural background of you and your partner?
Are there any religious or cultural requirements relating to your child/ren's upbringing that you would like us to honour in caring for your child/ren?
Are you or any of the children listed on this form Aboriginal or Torres Strait Islander background?
Aboriginal
Torres Strait Islander
Aboriginal and Torres Strait Islander
Neither
Unknown
Decline to advise
WHERE DID YOU HEAR ABOUT THIS SERVICE?
Our Shire
Internet
Have Used Before
Word Of Mouth
School Newsletter
Library
Other (Please Specify)
REASON CARE REQUIRED (X ONE only)
At Risk / Referral (e.g. DoCS Referred)
Working / Studying / Maternity Leave / Returning to work / Looking for Work
Respite Care - Not Working and Not Looking for Work
Are there any Court Orders or Custody Arrangements Relating to your Child/ren?
If Yes a certified copy needs to be supplied prior to the start of care
Child 1 / Child 2First Name
Surname
Date Of Birth
Gender
Child’s School
Country of Birth
Child’s CRN
Allergies#
Special Needs
Medical Conditions*
Child 3 / Child 4
First Name
Surname
Date Of Birth
Gender
Child’s School
Country of Birth
Child’s CRN
Allergies#
Special Needs
Medical Conditions*
* If your child has a medical condition, you will be required to provide a current medical management plan at the time of enrolling. Bookings will not be accepted until this documentation is provided. Plans will need to be updated annually from the date on the medical documentation or as changes occur to the child's condition for children returning to care and resubmitted.
# If your child has an allergy that requires medication if exposed you will be required to complete the Medical Management Plan
AUTHORISATIONS
Products§ Adhesive Dressing Tape
§ Plastic Bag For Amputation
§ Non-Adhesive Dressing Pad
§ Sterile Eye Pad
§ Conforming Gauze Bandage
§ Conforming Gauze Bandage
§ Disposable Latex Gloves / § Thermo Accident Blanket
§ Safety Pins - Assorted
§ Scissors - Sharp/Blunt Splinter Forceps
§ Sterile Eyewash
§ Antiseptic Swabs
§ Triangular Bandage
§ Band-Aids/Elastoplasts / § Sterile Wound Dressing
§ First Aid Guide Forehead Thermometer
§ Rapaid First Aid Spray
§ Rapaid Itch Relief Sachet
§ Disposable Resuscitation Face Shield
§ First Aid Tool Box (11090)
Authorisation / Details
Cancer Council Sunscreen 30+ / Active: - Octyl Methoxycinamate 60mg/g
- Butyl Methoxydibenzoylmethane 20mg/g
Other: - Phenoxyethanol 3mg/g
- Hydroxybenzoate 4mg/g
- Methylbenzylidene Camphor 30mg/g
Rid Cream Repellent / Active: - 160b LN, N-diethyl m Tuoluamide (DEET)
- 20g/1 N-Octyl Dicycloheptene Dicarboximide
- 10g/1 Di-N-Propylisocinchomeronate
- 1g/1 Tricolsan
Panadol Colour-Free / - 5ml contains 120 mg paracetamol
- Free from asprin, sugar and alcohol
Ventolin - (in the event of a suspect Asthma Attack) / - 100mg Salbutamol
- HFA - 134a propellant
Photography & Video / Use
For developmental, educational, publication or communication, purposes at the Centre
Student Documentation / Use
For TAFE and / or University Students to observe and document information about my child for the purpose of Early Childhood Studies. I am aware that all documentation will remain confidential and only first names will be used.
I give permission for all of the above items to be used on my child/ren
Children’s Names:
I give permission for the above items to be used on my child/ren EXCEPT the items listed below
Child’s Name / Items to not be used
PERMISSION FOR MEDICAL TREATMENT & AMBULANCE SERVICE / Initial
Yes / No
I authorise staff at the service to seek emergency treatment for my child from a registered medical practitioner including medical, hospital, dental and ambulance service (including ambulance transportation) should this be considered necessary.
Completed By: / Date:
Signature: / Date:
Monday 25th September 2017- Friday 6th October 2017
Please complete the sections below:
BOOKING OF DAY/S: (Please cross in the appropriate box the days you require)
r Denotes Compulsory excursion/activity days J Denotes Optional excursion/activity days
WEEK 1
ChildsName / Age / Monday / Tuesday / Wednesday / Thursday / Friday
25th September / 26th September / 27th September / 28th September / 29th September
r / J / J / J
1)
2)
3)
4)
Week 1 / Description / No. Children / Excursion Fee / Total Payable
Monday
25/09/17 / Fit Fantastic Sun Boot Camp (Compulsory Incursion) / X / $14.00 / = / $
Tuesday
26/09/17 / Sydney Aquarium (10-14 year olds Optional Excursion) / X / $35.00 / = / $
Wednesday
27/09/17 / Symbio @ Helensburgh (All Ages Optional Excursion) / X / $35.00 / = / $
Friday
29/09/17 / OOSH in the Bush (All Ages Optional Excursion) / X / $35.00 / = / $
Total Fee for Excursions Week 1 = $
Yes / No
If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre
You will be advised if any excursions/incursions are unavailable
** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date **
** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date **
Early Bird closing date is Sunday 17th September 2017 at Midnight.
BOOKING OF DAY/S: (Please cross in the appropriate box the days you require)
r Denotes Compulsory excursion/activity days J Denotes Optional excursion/activity days
WEEK 2
ChildsName / Age / Monday / Tuesday / Wednesday / Thursday / Friday
2nd
October / 3rd
October / 4th
October / 5th
October / 6th
October
J / r / J
1) / CENTRE CLOSED
2)
3)
4)
Week 2 / Description / No. Children / Excursion Fee / Total Payable
Tuesday
03/10/17 / Bee Garden Sutherland (Optional All Ages Excursion) / X / $20.00 / = / $
Tuesday
03/10/17 / Movies @ Miranda (10-14 year olds Optional Excursion) / X / $25.00 / = / $
Wednesday
04/10/17 / Silent Disco (Compulsory Incursion) / X / $15.00 / = / $
Friday
06/10/17 / Kidtopia @ Parramatta Park (Optional All Ages Excursion) / X / $35.00 / = / $
Total Fee for Excursions Week 2 = $
Yes / No
If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre
You will be advised if any excursions/incursions are unavailable