Enrolment Form

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Child's Full Name

Gender

Male
Female

Date of Birth

Home Address

Period of Enrolment

Annual
Semi Annual (6 Months)
Monthly

Starting Date

Primary Parent/Carer

Parent Full Name

Phone Number

Relationship to Child

Second Parent/Carer

Parent Full Name

Phone Number

Relationship to Child

Cultural Consideration

Language Spoken at Home

Religion

Medical Information

Does the child have any specific health care needs or conditions, including allergies or anaphylaxis?

If yes, please provide a medical management plan, which the child's medical practitioner has prepared. The Plan should include: A photo of the child If relevant, state what triggers the medical condition, allergy or anaphylaxis First aid needed Note: This can be uploaded at the end of this form.

Medication will only be administered if it is in the original container with the original label and instructions that can be clearly read and before the expiry or use by date. Additionally, if the medication has been prescribed by a medical practitioner:

The label must contain the child's name and
Parents must provide any verbal or written instructions provided by the medical practitioner.

Any medication, including non-prescription medication like nappy creams and paracetamol, must be authorised by parents or an authorised nominee on our “Administration of Authorised Medication” form.

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Parent 1

I acknowledge this.

Parent 2

I acknowledge this.

Do you authorise the Nominated Supervisor or another educator at the Service to seek medical treatment from a registered medical practitioner, hospital or ambulance service?

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Parent 1 (copy)

I acknowledge this.

Parent 2 (copy)

I acknowledge this.

Child's Routine

Describe Routine, Times etc etc

Emergency Contact

There may be times or situations where your child has had an accident, injury, trauma or illness and Parent/s cannot be reached or are unable to collect their child. To deal with these circumstances and in case of an emergency the Service will inform the following person to collect and care for the child. This person must live a maximum of 30 minutes from the Service and must provide identification when collecting the child. Please obtain the person's consent before listing them as an emergency contact

Full Name

Relationship to child:

Phone Number

Can this person be contacted to give consent for medical treatment or to authorise for a Nominated Supervisor or educator to administer medication to the child in the event that you cannot be contacted?

Can this person be contacted to give consent to the transportation of the child by an ambulance service?

Enrolment Agreement

PLEASE READ THE FOLLOWING AGREEMENT CAREFULLY BEFORE SIGNING. PLEASE ASK IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU ARE UNSURE OF Please tick the following items to authorise:

Have SPF50+ sunscreen applied prior to sun exposure

Have Band-Aids or sticking plasters applied when necessary

Have staff apply Nappy Cream/Paste (supplied by parents)

For photos and video footage of my/our child to be used in Learning Stories, and to be shared with other families that attend the Service

For photos and video footage of my/our child to be used on Service website, social media and other internet purposes, such as advertisement and used in organisation’s resources

Do you ONLY give permission for photos and video footage of your child to be taken for your own personal viewing