20 Hours Early Childhood Education Attestation Form

This form must be completed for every child enrolled to receive 20 Hours ECE at this service.

Please read this information below before you answer any questions and sign this form.

20 Hours ECE is available to three and four year old children who are enrolled and attending a licensed teacher-led early childhood education service. The maximum 20 Hours ECE that can be claimed for each child is 6 hours per day, 20 hours per week across all services that the child is enrolled in.

In order for your child to receive up to 20 hours ECE, this Attestation Form must be filled out by all persons enrolling children.

Please confirm that you understand the following: (Please tick boxes)

□You must complete a separate form for each child.

□Failure to complete this form will mean that this child is not eligible for funding for 20 Hours ECE.

□The purpose of completing this form is to confirm this child’s eligibility to receive 20 Hours ECE.

□If you make a false statement, or provide any false or misleading information, you may be committing an offence and be liable to prosecution.

□You authorise the Ministry of Education to make any enquiries it deems necessary regarding the information provided on this form to the extent necessary to make decisions about your child’s eligibility for 20 Hours ECE. You also consent to the early childhood service providing relevant information to the Ministry of Education, and to other ECE services your child is enrolled at, about the information contained in this form.

Please provide the following information:

Name of child:______Date of Birth:_____/____/____

Is the child receiving 20 Hours ECE at any other service(s)? Yes/No (Please circle)

Please confirm the daily and total time (hours and minutes) of 20 Hours ECE claimed at all services the child is enrolled at on the chart below and initial to confirm.

Date / Mon / Tues / Wed / Thurs / Fri / Sat / Sun / Total / Initials
Claimed at ECC
Claimed at another service
Total

I confirm that:

  • The child named above does not receive more than 20 hours ECE per week across all services.
  • I will immediately notify all services where the child receives 20 Hours ECE of any changes to the information provided above.
  • I have read and understood the information in this form and confirm that the information provided by me is true and correct.
  • I agree to pay the optional charges of $17.00 per session.Yes / No

Signed: ______Date: ___/___/______

Name: ______Relationship to child: ______

20 Hour ECE

Epsom Community Crèche has offered 20 Hours Early Childhood Education since Term 3 of 2009 for three and four year olds.

When your child turns three years old, you will be eligible to apply for 20 Hours Early Childhood Education. You will be required to do the following to complete your application in accordance with Ministry of Education guidelines:

  • Complete an Attestation Form which details where you are claiming 20 Hours ECE for your child and confirms your agreement to the optional charge.
  • Pay yourfees as normal when you receive your invoice at the beginning of term. Your fees will be detailed on your invoice as “Optional Charge” as opposed to “Fees”. If your child becomes eligible during the term, your invoice will be adjusted accordingly.
  • If you do not wish to be included in the scheme or we do not receive an Attestation Form from you, you will be invoiced at the full cost of $20.00/session for the term.

Optional Charge

Epsom Community Crèche is a “sessional” service (as opposed to “all day”) therefore it receives substantially less in its funding rate per hour, per child than the all day services. In order to ensure the continual operation of the Crèche, we request that the parents pay an “Optional Charge” of $17.00 per session for those children opting into the 20 Hours ECE scheme. This replaces the fees of $20.00 per session.

We would like to remind you that Epsom Community Crèche is a not-for-profit organisation and we are a registered charity. We do not seek to make a profit, only to cover our costs and ensure the continued improvement in the services we provide.

Please do let us know of any concerns or queries you have regarding 20 Hours ECE and Epsom Community Crèche’s inclusion in the scheme.

Kind regards

Epsom Community Crèche

Management Committee