Please return this form with proof of age (birth certificate/visa/passport etc) for us to make a copy

Child Name
First name / Surname
Middle Name / Preferred name
Date of Birth / Male / Female
Residential Address 1 / Postcode
Residential Address 2 / Postcode
(if in shared care)
Parent/Guardian Details 1
Mr/Mrs/
Ms/other / First Name / Surname
Mobile / Home Phone
Work Phone / Email
Address (if different from child’s)
Can we email you? / Yes / No / I would prefer mail
Cultural background / Contact Priority / 1. First Contact 2. Second contact
Main Language spoken at home? / Interpreter Required? / Yes / No
Parent/Guardian Details 2
Mr/Mrs/
Ms/other / First Name / Surname
Mobile / Home Phone
Work Phone / Email
Can we email you? / Yes / No / I would prefer mail
Address (if different from child’s)
Main caregiver / Y / N / Relationship to child / Account payee / Y / N
Cultural background / Contact Priority / 1. First Contact 2. Second contact
Main Language spoken at home? / Interpreter Required? / Yes / No
Parental Status
Two parent home / Sole Parent / Shared Parenting / Guardian
Custody
Is the child under the guardianship of the minister for Education & Child Development (goM) or alternative care? / Yes / No / If Yes, further details must be supplied.
Are there current court-sanctioned residency, parental responsibility or contact orders relating to the child? / Yes / No / If Yes, attach order
Primary School Details
Primary School Start Year? / Which school? / Term starting
(Private schools only)
Child’s Cultural Background
Country Born / If other than Australia,
date arrived / Visa copy provided? / Yes / No
Cultural/Religious requirements / Culture / Main Language
Aboriginal or Torres Strait Islander? / Yes / No / Other Language
Medical Conditions
Does the child have a diagnosed medical condition that may require support? / Yes / No / Health related dietary restrictions? / Yes / No
Asthma / Details
Diabetes
Toileting
Medications
Drinking/eating
Other
Allergies
Does the child have any allergies? / Yes / No
Bee / Details
Dairy
Gluten
Nuts
Penicillin
Yeast
Other
Doctor/Clinic Details
Doctor/Clinic Name / Phone
Address / Postcode
Medical Management Plan
If the child has any individual emergency or routine health care / medical management needs (e.g. seizure management, toilet support, diabetes management, supervision of medication, anaphylaxis first aid) the site will need a health care / medical management / medication plan from the treating doctor / health professional.
Health Care/Medical Management Plan Attached? / Yes / No
Immunisations
Has the child received all scheduled immunisations? / Yes / No
(Schedule as determined by Medicare National Immunisation Program, available from http://www.medicareaustralia.gov.au/provider/patients/acir/schedule.jsp) Note: If not, the child may need to be excluded from the site during outbreaks of some infectious diseases.
Additional Needs/Diagnoses Disabilities
Does the child have an additional need or diagnosed disability? / Yes / No
Autistic Disorder / Physical Impairment / Significant challenging behaviour / Undiagnosed Significant need
Global Development / Hearing Impaired / Speech & language impaired / Visual Impairment
Details
Agencies Accessed
Agencies Involved / Agencies Involved
Contact Person / Contact Person
Phone / Phone
Support Received
Concerns about development?
Do you have any concerns about your child’s development? / Yes / No
Eg behaviour, personal care needs, language skills / If yes please provide details.
Details
Emergency contacts if parent/guardian cannot be contacted
(Includes authority to collect child and provide overnight care)
PERSON 1
Mr/Mrs/Ms / First Name / Surname
Mobile / Home
Work / Relationship to Child
Address
PERSON 2
Mr/Mrs/Ms / First Name / Surname
Mobile / Home
Work / Relationship to Child
Address
Parent / Guardian Signatures
Do you access Childcare? / Yes / If yes, please complete details below / No
Centre Name: / Phone:
I / We authorise Prospect Kindergarten to contact the above centre to clarify access of DECD funding of 15 hours preschool program access*.
I / We authorise education and care staff to seek Medical treatment for the child from a registered medical practitioner, hospital or transportation of the child by ambulance service.
I/we agree to Prospect Kindergarten to contact by email via the Skoolbag App (as indicated on page 1). Email will only be sent as per the
E-Communication Policy and addresses shall remain confidential and not shared. I can opt out from receiving email at anytime.
I / We certify that all information given is true and accurate.
Signature Parent/Guardian 1 / Date
Enrolment accepted by / Date / Birth certificate sighted? Y / N
Permissions
I consent to my child applying sunscreen at kindergarten and understand that all children need to bring and wear a “Sun Safe” hat outside as part of our Sun Smart Policy.
Signature:
I consent to my child participating in multicultural traditions, celebrations and discussions at kindergarten.
Signature:
I consent to my child participating in short walking excursions, with staff, outside the kindergarten.
Signature:
I consent my child’s photograph being taken and used as part of the kindergarten program.
Signature:
DECD MEDIA CONSENT
Background
DECD develops teaching and learning and promotional materials and publishes them in print and digitally (on websites).
Request for Permission
DECD seeks permission to use the following:
- media (photo/film/audio recording) in which your child appears
- a written comment made by your child
- your child’s work samples (for example, a painting, written work, podcasts)
Granting Permission
By completing and returning this permission form, you are granting permission for the DECD to use:
- an image or recording of your child which appears in a photo, film and/or audio recording to publish on paper and/or on websites under a CC-BY -NC licence*
- your child’s work samples on paper and/or on websites under a CC-BY-NC licence*
- an image or recording of your child which may identify your child by first name and/or DECD school/preschool/service only
- work samples created by your child without identifying your child - or identifying your child by first name and/or DECD school/preschool only.
Notes
- Additional written consent by the parent / guardian must be obtained by the DECD school/preschool/service prior to publishing full names of children where they appear in media articles (eg: for awards or recognition of effort etc).
- Not every item for which permission is granted will be used. - Media, comments and/or work samples might not appear in exactly the form in which they have been submitted. - Media, comments and/or work samples which contain images of or references to Indigenous people will be accompanied by warning text to indicate that the work may include references to Aboriginal and Torres Strait Islander people who have passed away. - The material will be available to ‘the world’ to download and use under a CC-BY-NC licence*. This licence is perpetual(forever), irrevocable, free, worldwide, non-exclusive and allows for the replication, distribution, display, performance and remixing of copyrighted work for non-commercial purposes, provided that the author is credited.
*Creative Commons licensing by attribution, non-commercial This licence allows the replication, distribution, display, performance and remixing of copyrighted work provided that the author is credited and re-use of the material is restricted to non-commercial purposes only.
I give permission to the DECD and Prospect Kindergarten to publish media, comments and/or work samples.
Signature:
INFORMATION PRIVACY STATEMENT
The Department for Education and Child Development (DECD) is committed to respecting the confidentiality of information provided by children/students and parents, for example, information requested on child/student enrolment forms.
The information requested in this form is to enable DECD to:
·  undertake administration and care responsibilities including maintaining emergency contact information
·  communicate with you about important matters
·  provide all resource entitlements
·  provide first aid and plan for child/student health support requirements
·  collect necessary statistical information and undertake analysis of the composition and performance of the child/student population
·  meet reporting requirements, including to other government authorities and funding agencies.
If organisations are contracted on behalf of DECD to undertake tasks that require access to enrolment data, the contract(s) between DECD and those organisations will include strict confidentiality and disposal provisions. Although some items on the enrolment form are not mandatory to complete under the national regulations, provision of this information will be beneficial to your child’s school/preschool for planning and resourcing decisions. Only unidentifiable data is reported to the Australian Government. In accordance with State Government privacy principles (http://www. archives.sa.gov.au/privacy/principles.html), no personal information is reported publicly that could identify individuals. The information provided in enrolment forms is stored securely in local school/preschool and DECD databases. While your child is enrolled in a DECD site, other information will be gathered relating to your child’s education and wellbeing, for example, records of learning progress, absences from preschool, behaviour, health and social development reports, observations and assessments. The management of this information is governed by State and DECD policies to ensure the information is used only for the purposes stated above and is secure, private and confidential. The disclosure of personal information held by Government is regulated by the information privacy principles (see reference above). Unless required to do so by a law of the State or Australian Government, as permitted by the information privacy principles or in accordance with the information sharing guidelines (see below), DECD will not otherwise disclose the information to others without your consent.
INFORMATION SHARING STATEMENT
Information concerning you and/or your child/ren can and will be shared in DECD, which includes all preschools and schools. There will be occasions where sharing information with others outside DECD will be important to your child’s educational progress, safety or wellbeing. In these circumstances, DECD follows the SA Government’s Information Sharing: Guidelines for promoting the safety and wellbeing of children, young people and families (ISG).www.gcyp.sa.gov.au
Under the ISG your consent for the sharing of personal information about your child will be sought and respected in all situations unless:
·  it is unsafe / impossible to gain consent or consent has been refused and
·  without information being shared, a child or children will be at increased risk of serious harm.
The aim of information sharing under the ISG is to protect and promote the safety and wellbeing of children, young people and their families. This site works with parents/guardians and other agencies/services to achieve that aim. Parents/guardians are strongly encouraged to share all information relevant to their child’s capacity to enjoy and benefit from education:
·  by using the ‘any other information’ section of this form, and/or
·  in discussion with staff at the time of enrolment, and/or
·  in discussion with staff at any time in the future.

Sessions requested: Morning sessions 8.15 am to 12 noon

Afternoon sessions 12.30 pm to 3.45 pm

Lunchcare days 8.15 am to 3.45 pm (Mon/Tue/Wed only)

MON / TUES / WED / Lunch 1 / Lunch 2
am / pm / am / pm / am / pm

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