Enroll


Enrollment Form

PARENT DETAILS


 Yes    No
(Customer Reference Number from Family Assistance Office)

 Yes    No
(Customer Reference Number from Family Assistance Office)

Emergency Contact Information (next after parents)
Authorisation to collect child

Contact 1


Contact 2


Contact 3


Permission

 Yes   No
 Yes   No
 Yes   No
 Yes   No
 Yes   No
 Yes   No
 Yes   No
 Yes   No
 Yes   No

CHILD’S DETAILS



Male Female

 Yes    No
If yes, please provide details and a photocopy


 Yes    No
If yes, please provide details and a photocopy
 Yes    No
Proof must be shown to staff to enable us to retain a photocopy of details
Does your child have any allergic reactions? Eg foods, medication, grass, sunscreen OR any special dietary requirements or religious/cultural beliefs, eg vegetarian  Yes    No
Does your child have any medical conditions?
Eg asthma, convulsions  Yes    No
If yes, please state:
Does your child take any regular medication?
Eg Ventolin  Yes    No
If yes, please state:
 Yes    No
If yes, please state:

Child’s registered dental practitioner or service details

 Yes   No
Signed: Mother
Signed: Father
Signed: Parent3

Future school plan


Signed: Mother
Signed: Father
Signed: Parent3

Signing in and out

MEDICAL EMERGENCY

In case of accident or emergency, every effort will be made to contact the parents immediately. In the event that my child requires urgent Medical attention, I ___________________________________ (Parent/Guardian), authorise the staff of Walkley Heights Child Care Centre to obtain medical assistance which they deem necessary, and agree to pay any medical and transport costs incurred. I agree to indemnify Walkley Heights Child Care Centre, and its staff, against any liability relating to, or incidental to, Walkley Heights Child Care Centre custody and care of my child, except where such liability is directly caused by any willful act or omission of Walkley Heights Child Care Centre or its servants or agents.

Parent1
Date
Parent2
Date
Parent3
Date

FEE AGREEMENT

It is the responsibility of parent/guardians to ensure that the enrolment form is completed in full, and returned to the Centre prior to commencement of care. This form provides the Centre’s link to you as parents/guardians in case of an emergency.

I undertake to pay the fees weekly in advance.

I understand that the fees must be paid regardless of attendance, eg sickness, Public Holidays, or Annual Leave and I understand there will be no swapping of day or “making up” of days not attended.

Fees for holidays must be paid in advance prior to your child commencing such leave.

If my fees are in arrears for more than two weeks and no arrangements have been made with the Centre, my child’s place will be withdrawn. Should I fail to pay my fees and my place is withdrawn or when I leave the Centre I will be liable for all additional costs incurred by the Centre in collecting the outstanding fees.

Full fees are payable until my Child Care Benefit Confirmation is received by the Centre.

Notice: When my child is leaving Walkley Heights Child Care Centre or reducing the number of days of attendance, I must give two weeks written notice or pay appropriate fees in lieu of such notice

Parent1
Date
Parent2
Date
Parent3
Date

 Yes    No
(Customer Reference Number from Family Assistance Office)

Medication book - Permission

If your child requires Paracetamol (eg Panadol or Nurofen), asthma puffers, antibiotics, medicated creams, or any other medication, you will be required to complete the details in the Medication Book located in the child’s room.

The page will look something like this:

COMPLETED BY PARENT / GUARDIAN

COMPLETED BY EDUCATOR

If your child has had Panadol or Nurofen (or similar medication) before attending to child care, we require them to remain absent from the service for at least 24 hours, from their last dose in order to assist with preventing the spread of illness and infections across our service. Please speak with a staff member if you have any questions or concerns.

Payment

Days / Times you require our care

Days Arrival Time Departure Time

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. Walkley Heights Child Care Centre may need to request the following information from the Family Assistance Office:

 Details regarding your percentage and its currency, your current residential address and phone number.

Family Details

NAMES AND AGES OF SIBLINGS OR RELATIVES AT THE CENTRE



FAMILY DOCTOR DETAILS

MEDICARE NUMBER

PRIVATE HEALTH INSURANCE

AMBULANCE COVER

     Yes    NO
Things like…play musical instruments, speak another language, cooking from other cultures, reading to children, fundraising