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Enrolment Form Highfields Early Learning Centre 93 Highfields Road Highfields QLD Ph : 4615 5688.

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Primary Guardian Details Miss Ms Mrs Mr Other _______ Name CRN

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Primary guardian details miss ms mrs mr other name crn

Enrolment Form

Highfields Early Learning Centre

93 Highfields Road

Highfields QLD

Ph: 4615 5688

Child DetailsFirst Name: Last Name:Child CRN: Male Female DOB: ___/___/___COB: Language Spoken:Is the child of Aboriginal and/or Torres Strait Island Origin? (please tick) No, not Aboriginal or Torres Straight Islander Yes, Aboriginal Yes, Aboriginal and Torres Straight Islander Yes, Torres Straight Islander

Primary Guardian Details

Miss Ms Mrs Mr Other _______

Name

CRN

Mobile

Email

Male Female DOB ___/___/____

COB

Home Address

Home Phone

Mobile

Martial Status

Relation to Child

Authorised to Collect the child? Yes No

Secondary Guardian Details

Miss Ms Mrs Mr Other _______

Name

CRN

Mobile

Email

Male Female DOB ___/___/____

COB

Home Address

Home Phone

Mobile

Martial Status

Relation to Child

Authorised to Collect the child? Yes No

Booking Information

Date starting:

Monday Tuesday Wednesday Thursday Friday

Parent / Guardian Details (if Secondary Guardian details are the same write “same as Primary Guardian 1)


Employment details

Employment Details

Secondary Guardian Details

Employer Name

Work Address

Work Phone

Email

Occupation

Primary Guardian Details

Employer Name

Work Address

Work Phone

Email

Occupation

Emergency Contact Details

Approved persons will be contacted in emergency situations when the parents or guardian is not available (in order as listed). They are also authorised to sign out children from the centre without additional written permission.

Please supply at least two names, other than the parents/guardians, whom we may contact in the event of an emergency.

Contact 1

Name MobilePhone (H)

AddressPhone (W)

Relationship to childEmail Address

Do you authorise this person to collect your child? Yes No

Contact 2

Name MobilePhone (H)

AddressPhone (W)

Relationship to childEmail Address

Do you authorise this person to collect your child? Yes No

Contact 3

Name MobilePhone (H)

AddressPhone (W)

Relationship to childEmail Address

Do you authorise this person to collect your child? Yes No


Primary guardian details miss ms mrs mr other name crn

Family Details Page

Please provide details of any siblings or other family members that live in your household

NameRelationshipDOB

NameRelationshipDOB

NameRelationshipDOB

NameRelationshipDOB

NameRelationshipDOB

Family Profile Ethnicity Religion

Can your child speak English?Can you child understand English?

Would an interpreter be of benefit of the child during the settling in period? __________________________________

What religious or cultural practice would you like your child to observe? (please give details below_

Are they are any activities at the centre which may contravene your family values or beliefs?

Can you help with any of the following items to assist us to share and enhance your culture with the centre?

Posters Artefacts Cookery Dolls Musical Instruments Dress Up Clothes

Other items

Is their any other information you would like to share with us about your background/beliefs?

School Information

Does this child usually attend School? Yes No

When was, or when will this child be enrolled at school?

Child Custody Information

If parents are separated/divorced, it there a legal document specifying who has custody or or access to the child ?

No (go to the next section) Yes (please complete the following)

Name of the custodial parent:

Any additional information about access arrangements

Is their any court orders against a parent or family member? No (go to the next section) Yes(please complete the following)

Name of person Date of Issue

Is a copy of Court order attached? Yes No

If you have any further information and/or photos of this person please hand this to the director on enrolment


Primary guardian details miss ms mrs mr other name crn

Health & Medical Information

Contact details for Health Professions

Doctors NamePhoneAddress

Dentist NamePhoneAddress

Medicare NoPrivate Health Insurance Name & No

Preferred Hospital in Emergency

Does your child have any allergies? No (go to next question) Yes (please complete the following)

Anaphylaxis

Has your child been diagnosed at risk of anaphylaxis ? No Yes (please attach action plan)

Does your child have an epipen? No Yes

Has the anaphylaxis management policy for the centre been provided to you? No Yes

Has the risk minimisation plan been completed by the centre in consultation with you? No Yes

If you answer yes to any of the questions below you must provide a support letter from your local doctor

Allergies

Is your child Allergic to any food? No Yes

If yes, pleas specify which foods and the signs / symptom's to be aware of.

Is their any other allergies? No Yes

If yes please detail and specify the signs / symptom’s to be aware of

Asthma

Has your child suffer from Astham? No Yes (please attach action plan)

Does your child use ventolin? No Yes

Has the asthma management policy for the centre been provided to you? No Yes

Has the risk minimisation plan been completed by the centre in consultation with you? No Yes

llness /Injury /Medical etc

Does your child have a history of illnesses or injuries? No Yes (please provide details)

Does your child have a any current medical condition? No Yes (please provide details)

Is the medical condition a long Term condition ? No Yes (please fill out a Long Term Medical Conditions Action Plan)

Is your child currently on any prescribed medications? No Yes (please provide details)

Does you child have any special needs? No Yes (please provide details)


Primary guardian details miss ms mrs mr other name crn

Immunisation Details

To be eligible for childcare Benefit, your children must meet the immunisation requirement's if they are under the age of seven. Please see family Handbook for further information

Please detail your child’s immunisations to date in the table below

The National Immunisation Program Valid from July 2013

I understand that in the event of an outbreak of a vaccine preventable disease at the centre, the management must notify the Department of Health of an unimmunised children in the centre and that they will be excluded from attendance for such time as the Department deems necessary and that the daily fee is still applicable during this time.

Parent/Guardian Signature: ______________________________ Date: ______________


Primary guardian details miss ms mrs mr other name crn

Child Profile

The following information pages will be share with your child’s educators.

Child’s Name:Date of Birth: ___/___/____

Usual time awake:Usual evening bedtime

Daytime sleep (approximate time of day and length)

What does your child take to bed?

Any special bedtime routines

Are the any foods your child particularly likes or dislikes?

Does your child have any fears? (e.g noise, animals)

Does your child get upset when left with other people?

Does your child have any favourite songs and/or activities they play at home?

Language spoken by the child Languages spoken at Home

Cultural Background

Does your child have any disabilities or special needs?

What home discipline methods do or would you use?

Has your child been in care before? No Yes (please state what type of care)

Are they are any words that we may need to know that have special meaning to your child

How can we assist your child? What would you most want for your child at our centre? Are there any particular areas of concern that you feel we need to know about

What information do you consider important for you to know each day and what is the best means of communicating this with you?

Is there any further information which you feel may assist us in providing the service best suited to your needs and the needs of your child? (e.g recent significant events, family situations, religious beliefs etc)

Are their any skills that your or family members have that you would like to contribute to the Centres program


Primary guardian details miss ms mrs mr other name crn

Information Required for Children under 3 years of age

Pleas tick where appropriate and provide comments where necessary.

Eating Routines

Feeds self

Uses spoon or utensils

Uses cup

Uses bottle

Nursery Children

Toileting Routines

Nappies

Being toilet trained

Toilet Trained

Sleeping Routines

Sleeps in cot

Sleeps in Bed

Nursery Children


Primary guardian details miss ms mrs mr other name crn

CCB & CCR Information

To ensure that you are linked to our centre through the Child Care Management System (‘CCMS’) and to have Child Care Benefit (CCB) and Child Care Tax Rebate (CCTR) applied to your child care fees, you must contact Centerlink to link you up to CCB & CCTR. , please also confirm that they have the correct name and date of birth for both the parent and child who is registered for CCB.

Do you have any other children in care elsewhere No Yes (please list your other children below)

I understand that it is my responsibility to let the center know in writing if my other children stop using care elsewhere. I understand that I am responsible for communicating with Centerlink. I understand that if any details are incorrect then full child care fees are payable by me directly to the center until the details are corrected with centerlink.

Parent/Guardian Signature: _______________________________________________ Date

Allowable Absences

Each family is allowed 42 allowable absences each financial year. If you exceed 42 you will not be eligible to receive CCB for any absence days after this amount. If you are coming tpHighfields Early Learning Centre from another centre you must advise us of any previous absences accumulated in the current financial year. Please tick one of the following:

I am coming from another centre. My total allowable absences taken for this financial year thus far are ______ days.

I have not attended another centre this financial year, therefore I have no previous allowable absences accumulated.

Parent/Guardian Signature: ________________________________________________ Date


Primary guardian details miss ms mrs mr other name crn

Fee Information

Fees are to be paid weekly in advanced , you have the following options to pay your account: please tick the relevant box in which you are going to pay your fees.

Ezi Debit

Centerpay

Cash

EFTPOS

Direct Deposit ([please fill in the code you will use for payments of your fees)

I will be paying

Weekly Fortnightly

I agree to pay my fees according to what has been ticked above, I agree that if I miss one payment I will make the full amount owing on the next payment..

I understand that accounts are not to be more than 3 weeks behind, if they get to 3 weeks behind I will either pay the account in full or organise a payment plan, I agree that if I don’t either pay the account in full or organise a payment plan then my child's position at the centre will be cancelled.

SignatureName of ParentDate

Statement & Communication Options

Statements

Parent Statements are sent out on a weekly basis you can choose to receive them either by email or a printed copy, please tick according to how you would like to receive these statements

Email Print

Communication

We communicate to families in a range of ways (please see family handbook for more in depth details). We have monthly newsletters and also notes on upcoming events would you prefer to receive these by email or printed copy, please tick according to how you would like to receive written communication

Email Print

I give permission for the rooms to email my photos of my children throughout the year. I understand it is my responsibility to inform the centre if my email changes or I wish to change the way I receive the above information

SignatureName of ParentDate


Primary guardian details miss ms mrs mr other name crn

Enrolment Agreement

Parents/Guardian’s must read and initial each section of the enrolment agreement. Initial & signing this form means that have read and agreed to each of the terms.

1.Fees

I / We understand and accept that fees must be paid a week in advance including public holidays, for which my child is enrolled whether or not he/she is in attendance. I understand that that if my child is not collected from the centre by closing time I will incur a late fee penalty as specified in the Family Handbook. I understand that if my fees go over 3 weeks in arrears that my child’s spot at the centre could be in jeopardy.

2.Notice upon leaving Highfields Early Learning Centre

I / We am aware that two weeks notice must be given to the Director when terminating my child’s place. If this is not done, I will incur the normal full fee for this interim period

3.Emergency Administration of Paracetamol

I / We give permission for a senior staff member to administer paracetamol to my child in the event of a temperature exceeding 38 degrees celsius and emergency contacts cannot be reached

4.Emergency or Accidents

In the event of an emergency, illness or accident (when the Centre is unable to contact the Parent / Guardin or the Authorised Contacts), I / We give the staff at the centre consent to seek Medical or Hospital attention for our child. I / We agree to pay any expenses incurred for Medical treatment and transport.

5.Permission for Observations

I / We give permission for our child to be observed for staff, student or visitor purpose. Students and visitors will work in conjunction with your child’s educators. If questioning or testing is to be carried out ! / We will be asked for further permission.

6.Permission for Photographs

I / We consent to my child being photographed for the following purposes: Inclusion in their individual child portfolios, centre programming (displays in the centre),Inclusion of my child’s photo in their friends portfolios, newsletters. I understand if my child photo is to be used in public places (Facebook, Website, Marketing Materials etc) I will be asked for written permission.

7. Physical Wellbeing

I / We give permission to Highfields ELC to apply SPF30+ sunscreen to any unprotected areas of skin on my child when they are outside. ! / We agree for Centre staff to apply Insect Repellant to ur child where necessary for indoor or outdoor purposes. I / We consent to First Aid being administered to my child by a staff member who holds a First Aid Certificate. I/ We agree that all medicine, whether prescribed or non-prescribed, will be administered by staff according to instructions given by a medical practitioner. I / we will fill out a form giving full details of dosage and times required based on medical advice. I / We understand that the centre will notify me immediately if my child is sick, and I will arrange for the child to be picked up from the centre immediately.

8.Authorised Contacts for collection

I / We agree to give permission for people listed on this form as authorised to collect my child to do so, unless I notify the Director, in writing of any changes.

9.Leaving the Property

I / We agree to give permission for my child to move out of the centre grounds when necessary for situations such as fire drills.

10.Parent Handbook

1 / We acknowledge that we have received and read the Centre’s Family Handbook. I / We understand any changes to this handbook will be displayed on the Family communication board in the foyer area.

11.Centre Policies

I / We acknowledge that the Centre Policies are avaible in the centre foyer at all times to view. I / We understand that these policies will be reviewed on an ongoing basis, and that the centre director will ask for input on these reviews from us families. I / We understand any changes to polices that is relevant to families will be displayed in the foyer area.


Primary guardian details miss ms mrs mr other name crn

  • 12.Fees for Public Holidays

  • I / We understand that Public Holidays are charged at the normal daily fee rate and that complimentary make-up days will not be available.

  • 13.Infectious Diseases / Clearance Certificates

  • I / We understand that our child will be excluded from the Centre if they contract a contagious disease or condition. I / We understand that our child will not be accepted back into the centre until a ‘clearance certificate’ is issued from a Medical Practitioner. Please refer to our Centre Policies for further information.

  • 14.Presence of Visitors and Volunteers

  • I / We understand that occasionally the Centre may have visitors and/or volunteers assisting in the Centre. I / We consent to our child being in the presence of visitors and/or volunteers under the centre staff supervision.

  • By signing this form I / We declare and confirm:

  • I / We are lawfully authorised in relation to the child referred to in this enrolment form

  • All information provided in this Enrolment form is true and correct

  • I / We have read, fully understand and agree to comply will all of the polices and procedures detailed in this enrolment form including items 1 – 14 above, and any other policies and procedures advised by the centre either directly or by making them available for perusal at the centre.

  • Signature of Primary Parent / GuardianDate


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