Bonny Babes Enrolment Form

Transcription

1 Bonny Babes Enrolment Form Bonny Babes Christian Childcare Centre Hope Island Bonny Babes Christian Childcare Centre Coomera Bonny Babes Christian Childcare Centre Oxenford 77 Crescent Ave Hope Island QLD Yaun St Coomera QLD Ruth Terrace Oxenford QLD 4210 Phone: Fax: Phone: Fax: Phone: Fax: enrolments@bonnybabeschildcare.com.au Website: Child s Surname: Child s First Name: Child s Preferred Name: Child s Date of Birth: Age at Enrolment: Bookings and Orientation Permanent Weekly Bookings (please tick) and show Intended Use of Hours Monday Tuesday Wednesday Thursday Friday Orientation Date: Start Date: Office Use Only Received by: Date entered: Date of Enrolment: Class of entry: Teacher: New Enrolment Attached Immunization Record Birth Certificate Sighted Sibling Enrolment Teacher Informed Drivers License Sighted

2 Child s Details Child s Sex: Male / Female Childs Birth Certificate Sighted Child s Name: D.O.B Child s CRN: Child s Current Address: Country of Birth: Language spoken at Home: Please outline the Child s cultural background and if relevant any cultural practices you would like followed: Please outline the Child s religious background and if relevant any religious practices you would like followed: Please outline any dietary restrictions or considerations the Child may have (e.g. likes and dislikes. Details of allergies etc will be expanded on in the Medical section of the form): Is your child of Aboriginal or Torres Strait Islander origin? (Please tick) No not Aboriginal or Torres Strait Islander Yes Aboriginal Yes Torres Strait Islander Position of the Enrolling Child in Family: Name / Ages of other Children in Family: Have there been any major changes in your family that may affect your child? : Yes / No New Baby: Death in the Family: Moving House / Country / State: Separation of Parents: Other:

3 Milestone History Age of Rolling: Age of Sitting: Age of Crawling: Has your child had a hearing test? Has your child had a vision test? Yes / No Yes / No Does your child attend Speech Therapy? Yes / No *If so please provide details Agency involved: Contact person: Does your child attend an early intervention program? Yes / No *If so please provide details Agency involved: Contact person: Does your child have any additional needs or disability? Yes / No *If so please provide details Agency involved: Does your child have a specific Diagnosis? Contact person: Yes / No *If so please attach a letter from a medical practitioner outlining this Medical Information Child s Registered Medical Practitioner or Service Details Service Name: Practitioner s Name: Contact Numbers: Address: Medicare Number: Hospital Preference: Do you have Private Medical Insurance? Yes / No *If so please provide details Name of fund: Name of Package: Membership Number: Child s Registered Dental Practitioner or Service Details Service Name: Practitioner s Name: Contact Numbers: Address:

4 Medical History Has your child been Immunized? Yes / No If Yes, please provide a copy of your child s officially recognized immunization schedule If No, please write a letter outlining this to be attached to the enrolment form, including that you understand that your child may be required to be excluded from the service, as a precaution to the spread of a contagious disease. Has your child had any of these illnesses? *If so please provide details Measles: Yes / No Age: Seriousness: Rubella Yes / No Age: Seriousness: Chicken Pox: Yes / No Age: Seriousness: Mumps: Yes / No Age: Seriousness: Other Medical History of the child that we should be aware of: Does the Child have any specific health care needs or conditions? Yes / No Does the Child have any allergies? Yes / No Has the Child been diagnosed as someone who is at risk of anaphylaxis? Yes / No Does the Child have any dietary restrictions? Yes / No If you answered yes to any of the above, please attach relevant details. This includes a medical management plan, anaphylaxis medical management plan or risk minimisation plan. Please be advised that all medication administered at the service will only be given if the medication has been prescribed by a registered medical practitioner, from its original container, bearing the original label with the name of the child to whom the medication is to be administered, and before the expiry or use by date, from its original container, bearing the original label and instructions and before the expiry or use by date; and the medication must be administered in accordance with any instructions attached to the medication; or any written or verbal instructions provided by a registered medical practitioner. Education and Care Services National Regulations. Part 4.2, Regulation 95

5 Further Information about Child Does the child have any siblings? If so, please provide their names and ages. Does the child have any other close relations attending the centre? E.g. cousins. If so, please provide their names and ages. Please provide us with any other information we should know about your child (For example, favourite activities, fears, routines, special words (please translate if applicable), toileting and sleeping practices etc) Are you aware of what school you are planning to send to the Child to? If so, do you give the service permission to exchange information with the school in relation to transitioning your child to school? Name of School: Permission to exchange information: While public schools have no requirements for entry, some private schools may have entry requirements. Please outline if you are aware of any requirements the school you are planning to send the Child to have so we can incorporate them in to your child s program:

6 Parent / Guardian Details Parent 1 Parent Registered at Centrelink for Fee Relief (CCB) Relationship to Child: Does the child live with you? Yes / No Full Name: DOB: CRN for CCB: Other Names Known By: Country of Birth: Do you hold a health care card? Yes / No Health Care card Number Expiry Date Does the child attend another centre? Yes / No * If yes please nominate hours / days to be claimed at Bonny Babes: Do any other siblings attend care (OHSC, Vac Care)? Yes / No * If yes please provide a letter authorising Bonny Babes to use multiple child percentage against your fees Multiple child percentage to be applied by the centre: Are you eligible for the JET Program? Yes / No *If yes please provide a copy of JETCCFA eligibility letter from the Family Assistance Office in order for JETCCFA to be paid Please provide any relevant cultural background details: Home Address: Telephone: (H) (W) (M) Occupation: Place of Employment: Drivers Licence Number: Expiry Date: State: Drivers Licence Sighted Parent 2 Relationship to Child: Does the child live with you? Yes / No Full Name: DOB: Other Names Known By: Country of Birth: Please provide any relevant cultural background details: Home Address: Telephone: (H) (W) (M) Occupation: Place of Employment: Details of other individual considered to be a parent (Parent 3) Relationship to Child: Does the child live with you? Yes / No Full Name: DOB:

7 Other Names Known By: Country of Birth: Please provide any relevant cultural background details: Home Address: Telephone: (H) (W) (M) Occupation: Place of Employment: Medical Authorisation Do you authorise for the Nominated Supervisor or other educator at the service to seek medical treatment from a registered medical practitioner, hospital or ambulance service? Do you authorise for the Nominated Supervisor or other educator at the service to seek dental treatment from a registered dental practitioner or service in the event of an emergency? Do you authorise for the Nominated Supervisor or other educator to seek to transport the Child in an ambulance? Do you authorise for the Nominated Supervisor or other educator at the service to administer Panadol or Nurofen as per the manufacturer s recommendations that suit the Child (e.g. age, weight etc). A Nominated Person will be contacted each time the Child may require this. Should you only wish the Child to be administered with Panadol or Nurofen under certain circumstances, please outline these below. Name of product to be used (including trade name and form of strength): (If this varies from the product we use please note that you will be asked to provide this product)

8 Dosage to be administered: Condition or circumstance when this should be administered: Fever or temperature over: I understand the potential risks and side effects of this medication for my child. In the event of an emergency I agree to collect my child as soon as possible. In order to prevent a double dosage of medication being given to your child, please be advised that you must inform us if you have or haven t given your child their morning dosage before they arrive at the service. If you have not advised us, we will make contact before giving your child medication. Do you authorise for the Nominated Supervisor or other educator at the service to administer general first aid products as per the manufacturer s recommendations (e.g. paw paw creams or nappy creams, Stingoes, insect repellent) Please be advised that if the Child is diagnosed with asthma or anaphylaxis and an emergency occurs, the Nominated Supervisor or other educators may administer emergency first aid without making contact. Educators will notify the child s parents and/or emergency services as soon as possible. Education and Care Services National Regulations, Part 4.2, Regulation 94.

9 Court Orders Relating to the child 1) Are there any court orders, parenting orders or parenting plans relating to the powers, duties and responsibilities or authorities of any person in relation to the child or access to the child? Yes / No If yes, please provide all relevant documentation and paperwork 2) Are there any other court orders relating to the child s residence or the child s contact with a parent or other person? Yes / No If yes, please provide all relevant documentation and paperwork. Please note that without this documentation we cannot legally enforce the Order/s. Emergency Contacts Authorised Nominee means a person who has been given permission by a parent or family member to collect the child from the education and care service or the family day care educator. Education and Care Services National Regulations Part 4.7, Regulation 161 There may be times or situations where your child has had an accident, injury, trauma or illness and Parent/s cannot be reached. To deal with these situations the service will notify 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. Emergency Contact Person 1 Name of Individual: Relationship to Child: Address: Telephone: (H) (W) (M) Declaration of Consent for Being an Emergency Contact Person for the Child I, (PRINT FULL NAME) Agree to be an Emergency Contact Person for the Child and agree to be contacted in the case of an emergency involving this child. Signature of Emergency Contact Person Date:

10 Medical Authorisation for Child: Emergency Contact Person 1 Parent 1: 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? Authorisation to take Child outside of service: Emergency Contact Person 1 Parent 1: Can this person be contacted to give consent for the Child to be taken outside the service s premises in the event that you cannot be contacted? Emergency Contact Person 2 Name of Individual: Relationship to Child: Address: Telephone: (H) (W) (M) Declaration of Consent for Being an Emergency Contact Person for the Child I, (PRINT FULL NAME) Agree to be an Emergency Contact Person for the Child and agree to be contacted in the case of an emergency involving this child. Signature of Emergency Contact Person Date: Medical Authorisation for Child: Emergency Contact Person 2 Parent 1: 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?

11 Authorisation to take Child outside of service: Emergency Contact Person 2 Parent 1: Can this person be contacted to give consent for the Child to be taken outside the service s premises in the event that you cannot be contacted? Details of Other People who can collect the Child Authorised nominee means a person who has been given permission by a parent or family member to collect the child from the education and care service or the family day care educator. Education and Care Services National Regulations Part 4.7, Regulation 161 In the event that you or your nominated emergency contact cannot collect the Child, educator will use this list to arrange someone to collect the Child. This list may be added to throughout the year. Please list people in the preference you would like them to be contacted. Individuals must be able to produce identification when collecting the Child. Person 1 Name: Relationship to Child: Address: Telephone: (H) (W) (M) Person 2 Name: Relationship to Child: Address: Telephone: (H) (W) (M) Person 3 Name: Relationship to Child: Address: Telephone: (H) (W) (M) Sunscreen Protection As per our Sun Protection Policy we suggest all children to be protected against the sun with SPF 30+ sunscreen when exposed to sunlight. Our service offers sunscreen for all children. If

12 your child is allergic, sensitive or you would like another brand used, please be advised that we ask that you provide this brand. We ask that each family apply SPF 30+ sunscreen to their child prior to their arrival at the service in the morning. Copies of our Sun Protection Policy are available for families to view. Please ask our educators to supply you with one. Please Circle the statements applicable to you: YES I will apply SPF 30+ sunscreen to my child before coming to the service. YES Reapply SPF 30+ sunscreen to my child throughout the day to my child as required. NO I will not apply SPF 30+ sunscreen to my child before coming to the service. NO Do not reapply SPF 30+ sunscreen to my child throughout the day. Parent 1 Signature: Date: Please Circle the statements applicable to you: YES I will apply SPF 30+ sunscreen to my child before coming to the service. YES Reapply SPF 30+ sunscreen to my child throughout the day to my child as required. NO I will not apply SPF 30+ sunscreen to my child before coming to the service. NO Do not reapply SPF 30+ sunscreen to my child throughout the day. Parent 2 Signature: Date: Please Circle the statements applicable to you: YES I will apply SPF 30+ sunscreen to my child before coming to the service. YES Reapply SPF 30+ sunscreen to my child throughout the day to my child as required. NO I will not apply SPF 30+ sunscreen to my child before coming to the service. NO Do not reapply SPF 30+ sunscreen to my child throughout the day. Parent 3 Signature: Date: Photography Policy I consent to my Child being photographed during their time at Bonny Babes childcare centre. These photos may be displayed at the service and used throughout the enrolled children s portfolio documentation or may be used to promote the service within the community. Our Photography Policy is available to view at any time, please ask educators for a copy. No outside agency or individual will be allowed to photograph the children without parental consent. If the Child has a specific medical requirement, the Child s photo will be displayed on a sheet that details how to respond to the Child s medical requirements. This will be displayed in the service s kitchen. Please consent to your child s photo being displayed for this purpose.

13 Please Circle the statements applicable to you: Parent 1: YES I consent to my child being photographed while at the service and the photos being displayed and used for promotional purposes. YES I consent to my child being photographed and the photos being displayed at the service and in other enrolled children s learning portfolios, but these photos cannot be used for promotional purposes. NO I do not consent to my child being photographed. YES I give permission for my child s photo to be displayed on a Respond to Medical Condition sheet within the service NO I do not give permission for my child s photo to be displayed on a Respond to Medical Condition Sheet within the service. Printed Name: Signature: Date: Parent 2: YES I consent to my child being photographed while at the service and the photos being displayed and used for promotional purposes. YES I consent to my child being photographed and the photos being displayed at the service and in other enrolled children s learning portfolios, but these photos cannot be used for promotional purposes. NO I do not consent to my child being photographed. YES I give permission for my child s photo to be displayed on a Respond to Medical Condition sheet within the service NO I do not give permission for my child s photo to be displayed on a Respond to Medical Condition Sheet within the service. Printed Name: Signature: Date: Parent 3: YES I consent to my child being photographed while at the service and the photos being displayed and used for promotional purposes. YES I consent to my child being photographed and the photos being displayed at the service and in other enrolled children s learning portfolios, but these photos cannot be used for promotional purposes. NO I do not consent to my child being photographed. YES I give permission for my child s photo to be displayed on a Respond to Medical Condition sheet within the service NO I do not give permission for my child s photo to be displayed on a Respond to Medical Condition Sheet within the service. Printed Name: Signature: Date: Address We will periodically contact you via with our service s newsletters, family input sheets and statements. Please nominate an address that you would like these sent to

14 Request for Services In what ways might Bonny Babes assist your child? Why did you choose this centre? Do you have any particular skills you may wish to contribute to the program? eg. Chef, Music Has your child attended Kindy / Pre-School / Child Care / Family Day Care before? Yes / No * If Yes please specify Location and Name of previous Care Facility Does your child have any fears or dislikes? eg. Noises, dogs Yes / No * If Yes please specify Bonny Babes Facebook Disclaimer The official Bonny Babes Childcare Facebook pages have been created and maintained by the Bonny Babes Management and Educators for the purpose of maintaining communication with our Families. On all pages, it is expected that participants treat each other with respect. Comments will be deleted that contain vulgar or abusive language; personal attacks of any kind; offensive terms that target specific ethnic or racial groups or incite violence; election campaigning for a political office or ballot proposition. Comments that violate Facebook s Terms of Use are spam, clearly off topic, divulge personal Child or Educator information, or that promote services or products also will be deleted. Comments found on the site do not necessarily represent the outlooks of Bonny Babes Childcare. Links to other Internet sites are not endorsed by Bonny Babes Childcare and use of any copyrighted materials found on those linked sites must be granted from the sponsor of that site.

15 Bonny Babes Childcare is not responsible for user-generated content and the opinions expressed in that content do not necessarily reflect those of Bonny Babes as a whole. Terms of use By posting comments or the like on this page or on the photographs that are displayed on the page you agree to comply with the terms and conditions of Facebook. In particular you represent, warrant and agree that no content submitted, posted, transmitted, or shared by you will infringe upon the rights of any third party, including but not limited to copyright, trademark, privacy; or contain defamatory or discriminatory or otherwise unlawful material. Bonny Babes Childcare reserves the right to alter, delete or remove (without notice) the Content and remove at its absolute discretion for any reason whatsoever. Please sign below in agreeance with the Bonny Babes Facebook Policy, Disclaimer and Terms of Use: Privacy Disclaimer Bonny Babes Childcare Centre acknowledges and respects the privacy of its clients. The information that is being collected by Bonny Babes is to process your enrolment at the service and assist us to provide the best possible level of care for your child. By completing this form, you have consented to this information being collected. The intended recipient of this information is Bonny babes childcare centre, its authorised educators and relevant government authorities. You have the right to access and alter personal information concerning yourself or your child in accordance with the Privacy Act 1988 and the service s Confidentiality Policy.

16 Agreement Form Bonny Babes is required to collect and use personal and health information about families. This information is required to ensure the health and safety of your child whilst in our care, and to meet legislative requirements set down in the Commonwealth Child Care Program Handbook (Child Care Act 1972). As it is legislative requirement, failure to provide the required information will result in nonacceptance of your child s enrolment. The information you provide will only be utilised by Bonny Babes staff if it has a bearing on your child. All personal information is kept in a secure place to protect it from unauthorised access, modification or disclosure. Information may also be made available to the following departments on request: *The Office of Early Childhood Education and Care *DEEWR Please complete and sign the following: I / We agree to pay an enrolment fee of $50 per family. This is understood to be a non- refundable payment, this is not a bond. This will entitle you to an enrolment package. I / We agree to pay fees weekly for the days our child is booked in at the centre, using the Ezi-Debit Direct Debit, payment system. Upon enrolment I understand that I need to pay 2 weeks full fees upfront, and keep fees a week in advance at all times. If fees become 3 weeks in arrears, your child will not be allowed to attend the centre until such time as the fees are paid in accordance with this agreement. I / We understand that should this account be referred to a Debt Collection Agency an additional fee of 15% of the outstanding amount will be incurred. I / We understand that fees are payable even when our child is absent from the centre due to illness or family holiday. I/ we understand that if no notice is given for our child s absence, after 2 weeks their place will be given to another. I / We understand that 2 weeks notice is required if we wish to withdraw our child from the centre and agree to complete the required exit forms. I / We agree to pay full fees for the 2 weeks notice if my child does not attend the centre for this period. I / We agree that if my child does not attend the last two weeks of intended exit, we forfeit our entitlement of child care benefit to be a reduction against our fees and will be liable to pay full fees as a surcharge for the final weeks of care. (This is in accordance with the Child Care Management System). I / We understand that under the Child Care Management System, families are entitled to receive 42 days paid absences, holidays, sick days and public holidays are included in this. I / We understand that Bonny Babes is unable to provide Make Up Days for these absences and fees will apply as normal. I / We understand that once all of my 42 absences have been used, no fee relief will be paid on an absent day. Full fees will be charged for that day. If my child is absent due to illness, a doctors certificate will be required in order to apply for additional absence where fee relief is payable. I/ We as parents will endeavour to work in conjunction with the centre s policy to foster the well being of our child. Parent 1 Signature: Date: Parent 2 Signature: Date: Parent 3 Signature: Date: Witnessed By Staff: Position: Date:

17 CHILD CARE CREDIT AGENCY. PRIVACY STATEMENT As a child care centre, Bonny Babes must ensure that you, as parent or guardian of your child, fully understand the National Privacy Principles and the manner in which we must use your private information, and your child s private information, in order to carry out our role as a child care centre. Please take the time to read this Privacy Statement and our attached Privacy Policy carefully and once completed, return it to this office with your enrolment form. As child care centre operators we collect personal information about you. All unpaid child care provided by the Centre to your child is provided to you on credit. The Centre is a credit provider in accordance with the Privacy Act 1988 (Cth) (Act). Purpose We collect your personal information to ensure that we hold adequate information in relation to you and your child and to ensure that you are able to pay for our costs of providing your child with care. To carry out this role, and during the term of your child s care, we usually disclose your personal information to: The Child Care Credit Agency Pty Ltd ACN (CCCA); Marshall Freeman Debt Collection Agency Your personal information includes, but is not limited to, your name, your child s name, your address, your child s address, your / your spouse s customer reference number, your child s customer reference number, your / your spouse s driver s license number, your / your spouse s Medicare number, your / your spouse s payment history. We may also use your personal information to conduct searches in relation to your present / past payment history. If your personal information is not provided to us, and you do not consent to the uses to which we put your personal information, we cannot properly assess whether you will be able to pay for your child s care, or whether we will have sufficient funds to carry out our duties as a child care centre. Consequently, we then cannot provide your child with care. PROCESS OF APPLICATION In addition to the above general conditions of enrolment I/we agree that, for the purposes of processing my/our application for enrolment,: 1. I/we agree that the Centre may seek consumer credit information (Section 18K (1) (b) Privacy Act 1988) about us.

18 If the Centre considers it relevant to assessing my/our application for commercial credit, I/we agree to them obtaining from a credit reporting agency a credit report containing personal credit information about me/us in relation to commercial credit provided by the Centre. CCCA DISCLOSURE STATEMENT You can contact the CCCA and ask for access to any of your personal information stored on the database by: Telephone: Facsimile: (07) Visit website: admin@childcarecreditagency.com.au The CCCA collects information to provide to its members and others listed below, current and historical credit information on individuals who/which utilise child care facilities from or through the child care centre members of the CCCA. The child care centre will advise the CCCA of your conduct throughout your use of the child care centre, and that information will form part of your credit history. The CCCA usually discloses information to: Other child care centres who are CCCA members; Any nominated debt collection agency engaged for the purposes of debt collection and other services; and Credit bureaus. The Centre will take all necessary steps to protect your personal information in its possession against misuse or loss and it will return all such information to you (or if requested by you, destroy or de-identify such information) upon termination or expiry of this agreement. This clause will survive the termination or expiry of this agreement. By signing the below you agree: (a) With the attached Privacy Policy;

19 (b) That the Centre may obtain personal information about me/us, including a credit check from other credit providers or a credit reporting agency (c) That the Centre may give your personal information to the CCCA; and Marshall Freeman (d) To the CCCA giving access to your personal information to: i. other child care centres who are CCCA members; ii. Collection House Limited; and other registered mercantile agents. iii. Credit bureaus. Parent 1: SIGNED by parent / guardian in the presence of: Parent 1 Name: Staff Name: Parent Signature: Staff Signature: Parent 2: SIGNED by parent / guardian in the presence of: Parent 2 Name: Staff Name: Parent Signature: Staff Signature: Parent 3: SIGNED by parent / guardian in the presence of: Parent 3 Name: Staff Name: Parent Signature: Staff Signature: