Rainbow Childrens Centre Woodburn OOSHC Enrolment Form B 2017
Details permissions & authorisations2017
Child's namesexDate of Birth.
Home Address
Post code Home Phone
Email address
Parent full names and best contact numbers while child is at the centre
(please note parent full name and parent date of birth is required for Child Care Benefit approvals)
parent 1 full name date of birth
daytime phone mobile
parent 2 full name date of birth
daytime phone mobile
Person(s) to contact in an emergency (other than parent )
Name relationship to child
Phonemobile
Address
Namerelationship to child
Phone mobile
Address
Persons other than parents authorised to pick up your child at the centre
Name :relationship to child
Phone mobile
Address
Name :relationship to child
Phone mobile
Address
Name :relationship to child
Phone mobile
Address
Signaturedate
ABOUT YOUR CHILD’S HEALTH
Is your child immunised?YesNo(please circle)
Your child's usual medical practitioner :Name
PhoneAddress
Your child's usual medical practitioner :Name
PhoneAddress
Family Medicare Number
Is there any medical/emergency information we should know, e.g. does your child have any recurring illness or condition such as epilepsy or asthma? If so, please state the condition and treatment
Please complete an emergency action plan if your child is asthmatic, or has epilepsy or an allergy
Is your child on any regular medication, and if so, what kind and for what condition ? .
Is there anything we should know about your child’s past medical history (any serious accidents, any trauma’s suffered during or soon after birth)?
Does your child’s suffer with frequent infections (e.g. ear, nose and throat etc.).?
Has your child had any allergies to food, drugs or insect bites ?
Does he/she have sensitive skin and are there certain soaps, lotions etc. we shouldn’t use on them?
Has your child ever been hospitalised and if so for what reason ?
Do they have any problems with urinary infections ? If so, please give details
Are there any Custody orders; Residence orders; family court orders; or other matters re custody of your child that affects who has access to the child? If so, please provide a copy so that the centre can operate in accordance with the orders.
PERMISSIONS AND AGREEMENT TO ENROL CHILD
I, (Name)agree to the following conditions for the
enrolment of my child.at Rainbow Children’s Centre
I understand that my child will be excluded from the centre for a period consistent with the recommendations of the NSW Dept of Health if he/she is suffering from any contagious or infectious illness and I must provide a doctors certificate stating that my child no longer presents a risk to any other child at the centre before he/she will be re-admitted.
SignedDate
I agree to provide evidence of my child’s immunisation status and understand that if my child is not immunised in accordance with the recommendations of the NSW Dept of Health, that he/she may be excluded from the centre for the period of the outbreak of the infectious disease.
SignedDate
I authorise the administration of paracetamol to my child, in accordance with the recommendations of the NSW Department of Health, if it is considered necessary in the event of my child experiencing pain, high temperature or teething whilst at the centre and authorise the centre to apply sun cream, insect repellent or band aids as required by my child.
SignedDate
In the event of an accident, injury or illness, I expect that I will be contacted before any medical attention is given to my child. If I am unable to be contacted, I authorise Rainbow staff to obtain such medical assistance or treatment for my child as may be considered necessary, and for this purpose engage any doctor, nursing assistance, ambulance, dentist or hospital treatment. In that event I agree to pay any fees or expenses incurred.
SignedDate
I understand that the centre does not provide nor endorse any babysitting arrangements with Rainbow staff outside the premises or hours of operation of the centre.
SignedDate
I am aware that I have certain responsibilities to comply with as a parent of the centre and am aware of the need to provide accurate and complete information to the centre, which will allow centre staff to provide appropriate care for my child.
SignedDate
I am aware that the centre staff may take photos of my child engaged in everyday educational experiences and positive interactions with other children and staff while in the care of the centre. Some of these photos may be used for publication in the centre brochures, parent handbooks, newsletters, web site photo gallery and display boards in the centre to support the centre’s educational program, promote the service and communicate to families the value of play and education. I authorise the use of my child’s photos for the purposes described.
SignedDate