Kidskorner.net.au

Child’s Details
Child Customer Reference Number (Provided by Centrelink): Is there anyone prohibited from having contact with your child? Custody Orders or Apprehended Violence Orders: Yes (if yes please provide details and copies) Under NSW Centre–Based Child Care Regulations (2004) you are required to provide a copy of your child’s birth certificate: Booked Days and Times
If you applying for Child Care Benefit to reduce fees please provide your Family Reference Number: Wednesday
Thursday
Does your child attend another service in the same week as attending Kids Korner? (If the answer is yes, please fill out a claimable hours consent form from the office) Family Details
Parent 1 Details: (Parent linked to CCB)
Parent 2 Details:
(this is required to collect Childcare benefit from the Govt) (if both parents are linked to the Govt Childcare benefit) Languages: ______________________________________ Immunisations
Has your child been immunised?
Is your child up to date with their immunisations: Please supply evidence of your child’s immunisation. Either their blue book or a letter from your doctor.
Allergies
Does your child have any allergic reactions? (e.g. foods, medicines, sun cream): Medical Conditions (if answered Yes to any of the below conditions, a plan from you Doctor will need to be provided for staff
to be able to administer the medicine at the centre)
Does your child have any medical conditions? (e.g. Asthma, Epilepsy): Does your child take any regular medications? (e.g. Ventolin, Insulin): Additional Needs
Does your child have any additional needs/ challenging behaviours? Does your child regularly visit a specialist? (e.g. Speech Therapist) Religious Requirements
Are there any religious requirements you would like us to follow? Can your child participate in festivals/ celebrations? Are there any religious requirements in case of accidents? Food/ Meals
Does your child have any special dietary needs? (e.g. vegetarian, no dairy etc.) Authority to Collect/ Emergency Contacts:
In the boxes below, list at least two people, over the age of 18, authorised to collect your child and at least two people that we may call
if we cannot contact you in an emergency. These may be the same for both. Friends and family not listed are not able to collect your child. Do not include parent’s names.
Medical Emergency
In the event that my child requires medical attention due to accident, illness or an emergency, and all efforts made by Kids Korner
staff to contact parents/ guardians/ other authorised persons have been unsuccessful, I authorise the staff of Kids Korner to obtain the medical, dental, hospital and ambulance assistance they deem to be necessary, and agree to pay any medical/ transport costs (To be signed by both parents or guardians where applicable) Medical Practitioners
Permission
I give staff of Kids Korner Tuggerah the authority to:
• Use the name and photo of my child for centre displays.
• Use the name and photo of my child for website content / advertising.
• Be observed by staff and students for developmental purposes.
• Apply sunscreen for outside play.
• Administer Children’s Paracetamol to my child if his/ her temperature exceeds that of 38* C and places the child at risk of convulsion. (you will be contacted first for verbal verification) Parent Signature: _____________________ Parent Signature: _________________________ Date: ____/____/____ (To be signed by both parents or guardians where applicable) Payment Agreement
I/ We understand that:
Fees are payable the first day of the week which my child attends.
If fees are in arrears for more than two weeks and no arrangement has been made with the centre manager, my child’splace will be withdrawn.
Fees are charged for booked days. If my child does not attend their booked days due to illness, holidays, public holidays orparental RDO days, fees will still be charged.
I need to provide two weeks notice prior to withdrawing from the centre and will agree to pay all outstanding fees prior to mydeparture. Should I fail to pay my fees and my place is withdrawn, or when I leave the centre, I will be liable for all additionalcosts incurred by the centre in collecting outstanding fees.
Full fees are payable until Child Care Benefit confirmation is received by the centre (To be signed by both parents or guardians where applicable) Information Agreement
I/ We understand that the information I have provided here and information that is gathered while my child attends Kid Korner,relating to my child and family, is treated by Kids Korner staff as confidential.
I/ We understand that Kids Korner at times will have to share particular details to relevant government offices. Kids Korner willex- change information with the Family Assistance Office regarding your Child Care Benefit and it’s currency as well as thebooked days for your child. Under special circumstances Kids Korner may need to exchange information with CommunityServices or the NSW Children’s Ombudsman’s Office.
I / We understand that information exchange with any other agency will require parental permission. For example, speechpathologists or an Early Intervention Team (To be signed by both parents or guardians where applicable)

Source: http://www.kidskorner.net.au/documents/ENROLMENT_FORM_2012.pdf