First Academy Pre School Child Care Centre

FIRST ACADEMY PRE SCHOOL CHILD CARE CENTRE

ENROLMENT FORM
35 Carinya Road Girraween NSW 2145
Telephone: 02 9863 2361
Fax. 02 9863 4361
E mail:
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This Enrolment form must be accurately completed as it will be kept and referred to as legal document. It is important that the information be kept up to date, so if there are any additions or changes, please notify the director.
Please Note that all information you provide in this form will be treated as STRICTLY CONFIDENTIAL.
Please remember to provide the blue bookorevidence of immunization tocentre (IT IS A MUST).
For childcare benefits, please call Centrelink on 136150 and quote centre’s provider number 407199898S
MONDAY / TUESDAY / WEDNESDAY / THURSDAY / FRIDAY / COMMENCING SERVICES FROM
Arrival Time / __ __ / __ __ / 2016
Departure Time
Child’s First Name……….……….Child’s Family Name: …………………… C.R.N.______Date of Birth: ___/___/20_ _ Place of Birth: ……………Gender: □Male □Female
Cultural Background ……..…….. Religion (optional) ………….. Language…………….
Address (Full)…………………………………………………………………………………………………..…. Post Code: _ _ _ _
Is your child affected by any Court Order prohibiting contact with your child? ………….. □ No □Yes
Please provide details. ……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………
Parents Details Parent 1 ( Claiming CCB) Parent 2 Notes
Title
First Name
Surname
D.O.B. / / / 19 / / / 19
Customer Ref. No.
Address (If different)
Suburb & P. Code
Home Ph. No.
Mobile No.
Work Ph. No.
Work Address
E mail
Emergency Contact details (other than Parents)
NOTE: Parents are authorising the below persons to have access to their child or be contacted by the centre in an emergency.
(1) Full name ……………….…………Relationship to child …..….……Home Ph. ______Work Ph. ______
Address …………………….……………………………………..……..……………P. Code _ _ _ _ Mobile ______
(2) Full name ……………….…………Relationship to child …..….……Home Ph. ______Work Ph. ______
Address …………………….……………………………………..……..……………P. Code _ _ _ _ Mobile ______
Doctor’s Name:……………..……….. Phone: ( _ _ ) ______Release Child to the Dr:□Yes □No
Address:……………………………………………………………………………………….. P. Code: _ _ _ _
Medicare Number: _______ Private Health Insurance Membership No.:…….. ………………………..
Dentist, other specialist’s name:……………………………..…………….. Phone: ( _ _ ) ______
Address:…………………………………………………………………………………….. P. Code: _ _ _ _
Release Child to the Dr: □Yes □No
Other non school Children in the family:
1-Name…………………………………Age ……... M / F… 3-Name…………………………….. Age …… M / F
2-Name…………………………………Age: …….. M / F 4-Name…………………………….. Age.…... M / F
AUTHORISATIONS &PERMISSIONS
Permission for emergency or accident:
In case of accident, illness or emergency concerning my child and educator being unable to contact me, I consent to the Centre management seek and carry out on my behalf medical, dental, hospital or ambulance attention for my child and I accept liability for medical, dental, hospital and ambulance expenses as may incurred.
Parent Name & Signature:______- Date: _ _ / _ _ /2016
Medication
I understand that for medication to be administered to my child, all relevant information must be written into the medication sheet each day and I must sign to confirm the authorisation for medication to be administered.
I understand that prescribed medicine will be administered and it must be with my child’s name on the label.
I hereby authorise centre educator to administer the recommended dosage of Panadol should my child have high temperature (Above 38C), and I will seek the advice of a medical practitioner.
Parent Name & Signature:______- Date: _ _ / _ _ /2016
If a child becomes ill
I understand that if my child contracts any of the following, he / she may not be allowed to attend the centre until cleared of condition, a clearance certificate from authorised medical professional may be requested.
Temperature above 38C / Head lice / Vomiting Mumps
Sever skin rash/infection / Headache / Rubella(German measles) Measles
blistering (possibly taphylococcal) / Conjunctivitis / Infectious Hepatitis Chicken pox
Stiffness of the neck / Diarrhoea / Diphtheria
Aversion to light (photophobia) / Excessive discharge from eyes, ear or mouth
Severe pain anywhere / Any difficulty breathing (asthma, wheezing),
drowsiness or any unusual state of consciousness or behaviour
Swelling of the lips, mouth, tongue, throat, neck or airways
I understand that my child will also be excluded from the centre when an outbreak of an immunisation related disease if his/her immunisation schedule or records at the centre are not up to date as he/ she may beconsidered as unimmunised.
Parent Name & Signature:______Date: _ _ / _ _ /2016
Permission to take the child on local excursions
I give permission for my child to participate in local excursions from the Centre by foot.(A separate authorisation form may be required, see detailed policy in the policy folder – Foyer).
Parent Name & Signature:______Date: _ _ / _ _ /2016
Permission for Observations
I consent to my child to be observed by teachers for the purpose of providing training and keeping developmental records. However if questioning or testing of the child is undertaken, my permission will be sought beforehand.
Parent Name & Signature______Date: _ _ / _ _ /2016
Permission for photo and video taped
I hereby consent that my child’s to be photographed and or videotaped for the use within the centre, for centre’s advertising, marketing or news items.
Parent Name & Signature______Date: _ _ / _ _ /2016
Information Authority
The Family Assistance office can provide your information to someone else in special circumstances, where Commonwealth legislation allows or requires, or where you give permission. First Academy Child care centre may need to request the following information from the family assistance office:
Details regarding your Child Care Benefits percentages and it’s currency,
Your current residential address and phone number.
I give the Family Assistance Office the authority to provide First Academy Child Care Centre with information regarding my Child Care Benefit percentage and it’s currency and my current residential address and contact phone numbers.
Parent name &signature:______ Date: _ _ / _ _ /2016

CONDITIONS OF AGREEMENT

Enrolled Child’sname: ……………………………………………………………………………………
Start Dateof Agreement: _ _ / _ _ / 2016
I / we consent to and understand all the following conditions:-

Proof of my child's immunisation status is to be provided upon enrolment and updated regularly (reminder notes will be posted to parents to remind them about their child immunisation and when it is due). In case of a vaccine preventable disease break out, children with no updated records will be considered as unimmunised and will be excluded from centre. Also the centre will follow all other regulations and guidelines of Health Authorities in regards to exclusion of ill or unimmunized children.(Please read full details about immunisation and exclusion policies available in the Policy folder- Foyer)

A Doctor’s Certificate giving clearance must be presented if my child is suspected or suffering from an infectious disease, before he/she returns to the Centre. The educators have the right to refuse a child attending the centre if they believe the child is too sick to participate at the centre.

In the event of an emergency, illness or accident concerning my child and the educator being unable to contact me/us or the persons so authorised by me/us, then I/we consent to the Centre to seek medical, hospital, dental or ambulance attention for my child on my/our behalf also I/we consent to accept the liability for any expenses that may be incurred.(Please read full detail of the policy in the policy folder – Foyer)

The centre is closed during public holidays yet fees are payable for all Public Holidays and days of absences due to a child’s ill health or holidays.(Please read full detail of the policy in the policy folder – Foyer)
The child must be signed IN/OUT in the attendance sheet everyday of care.

At no time, a child will be left unattended but a late fee will be charged for the late collection of children after the closing time at the rate of $30 for the first 10 minutes then $2 per minute thereafter. (Please read full detail of the policy in the policy folder – Foyer)

Fees are to be paid minimum one week in advance. If the fees are in arrears, a late payment fee of $10 will automatically apply to any account with any overdue balance, this late payment fee is non refundable and will apply weekly. also a daily interest at the rate of 10% may be charged to the account and any additional costs or fees incurred due to fees collection or legal proceedings will be added and payable by the account holder.(Please read full detail of the policy in the policy folder – Foyer)

Fees will be charged for all booked days that the child does NOT attend due to illness, holiday, public holiday, RDO’s or any other reason.Centre management is to be notified if the child is not attending or away (family holiday) prior or on the particular day or days. Fees are to be paid using direct debit or automatic direct deposits, cash or cheque paymentare accepted if made for minimum two weeks in advance.

Upon enrolment acceptance, a holding refundable deposit (Bond) per every application equivalent to (2) TWO weeks or more of the fullfees to be paid before commencement of care. This is separate from ongoing childcare fees.

Three weeks written notice is required to stop the care, reduce or change child’s attendance days. The bond will be refunded after final reconciliation of Child’s fee account, one week after last booked day or last day of notice (Please read full detail of the policy in the policy folder – Foyer)

A $50 administration fee and $50 cancellation fee will apply and be paid by the parents if enrolment is terminated within three months or less.

The parents are responsible for ensuring their information with Centrelink or other agencies are correct and up to date if they are claiming Tax Rebates or Child Care Benefit from the Family Assistance Office.

More details available in the centre’s policies book or discuss with the Director any other concerns.
Upon acceptance of my child at the Centre, I declare that I read, understood and agreed to abide by the above conditions, other centre’s policies and procedures and all future arrangement and conditions released and communicated by the centre’s management.
Parent’s name & signature : / Date……./…../2016
Parent’s name & signature : / Date……./…../2016
Note: Must be signed by both parents / guardians where applicable
CHILD’S INFORMATION: (Copy of this page will be kept with the teachers in the room of the child)
Please make arrangement to spend 10 to 20 minutes on first day to discuss the following with aneducator.Thank you.
Child’s Full name: ………………………………………Child’s preferred Name ……….……. Date of birth / /20
Parent (1) Ph / Mobile ______Parent (2) Ph / Mobile ______Other Contact Ph No ______
Health & Medical Information.
Please supply evidence for immunisation (The Blue book, immunisation history form or letter from your family Doctor)
Has your child been immunised? □Yes □No Is the immunisation up to date? □Yes □No
Is your child’s immunisation schedule and immunisation records documentation up to date? □Yes □No
Is your child on regular medication? □Yes □No Please give details: ……………………………………………………………………………………………………………………………………….…
Has your child had any of the following? □Asthma □Mumps □Measles □Chicken Pox □Hepatitis □Other, Please give details and action plan for dealing with the condition ……………………………………………….……
Does your child have any ALLERGIES or Food sensitivities the centre should know about? □Yes □No
Please give details (Any food, sand, grass, medicine, sunscreen, etc………………..…………………………………………
Please give details about any other information you wish us to know about your child? ……………………………………………………………………………………………………………………………………………
Language Development,
Does your child speak / understand English? □Yes □No
Please name other languages (Special words if any) your child speaks at home? ......
Has your child ever had a speech assessment? Please details………………………………………………………………….
Is there any additional information that you like to tell the centre? …………………………………………………………….……………………………………………………………………………..
Social, cultural and special consideration,
Has your child been in approved care or with other people (baby sitter, relative)? Please give details……………………….
Is there any special information relating to your child (special fears, worries, habits, etc)? please give details
………………………………………………………………………………………… …………………………………………………
Is there any information about your family’s culture or religion that the centre and educator need to know? Please give details, …………………………………………………………………………………..
Are there any activities in the centre which may contravene your family values or beliefs?
Please give details about any special consideration for your child that we should know? ………………………………………………………………………………………......
Daily Routines,FOOD &EATING, □food intolerances, (please provide formal certificate)□religious or cultural
Does your child eat □With help? □Independently?
Are there any foods your child is NOT allowed to have? □No □Yes
If Yes, Please give details………………………………………………………………………………………………………….…
Does you child have particular food likes/dislikes? Details please…………………………………………………………
Are there any special words that your child uses for any food? …..………………………………………………………………………………………………………………………………………..
Is your child on Formula? □No □Yes, Please give details………………………………………………………..….
Daily Routines, REST & SLEEP, Does your child sleep during the day? □Yes □No
At what time?...... For how long? _ _ _ _ min./ hrs
Does your child have a □nappy, □Dummy, □Bottle, □security blanket or □any other item at sleep time? Please specify………………………………………………………………………………………………………………………………….....
Daily Routines, TOILETING,
Does your child need a nappy all day? □Yes □No Does your child need a nappy rest time only? □Yes □No
Is your child able to use Potty / toilet independently? □ Yes □No
Are there any special words that mean toilet to your child? ......
Other, Are there any Information or circumstances that may impact your child behavior at the centre?......
………………………………………………………………………………………………………………………………………….
Is there any information about your child you like the centre educator to know about?......
Parent’s Name: …………………Signature …………Educator……….………signature ……………__/__/2016
Note: Photo and video authorization consent form must be signed upon the start of care at the centre.

Authorisation Form

Dear Parent/Guardian

As part of our ongoing commitment to meeting your needs and that of your family as well as documenting centre's operations as per government requirement, we use photos, videos or other digital and media tools in operating an e-programming format for our daily journals, individual portfolios and other centre's purposes.

By signing the consent below you are agreeing to:

The use of photographs, video recordings and/or audio recordings of your child at play in any e-programming formats!

The viewing of such photos by other families whose children are enrolled at the centre.

The information and images remain the property of First Academy Preschool Childcare centre and will not be used without the express written consent from the centre and parent notification in case of publicity events.

Parent's Name ...... / Signature ......
Child's Name ...... / Date __ __ / __ __ / 2016

Thank you for your assistance,

Management/ First Academy