Townsville South State School – OSHC Enrolment Form

TSSS – ASCEnrolment Form

Dear Parents,

Please complete the attached form for Townsville South After School Care.Please note that bookings will carry over across the year, however a new enrolment form MUST be completed at the commencement of a new year to ensure continued care.To enquire about your Child Care Benefit (CCB) or your Child Care Rebate (CCR), please contact the Family Assistance Office or enquire online at familyassist.gov.au

Fees are $20.00 per day before CCB or CCR on all permanent days, and $22.00 per day before CCB or CCR on all casual days. If your child is absent and we aren’t informed by 2:30PM on the day, there is a charge of $10.00 per day before CCB or CCR. If you fall over $150 in debt to the centre, action may be taken.

Please note that we now only accept EFTPOS payments unless otherwise organised with the Coordinator and the P&C Association Treasurer.

If you would like any further information about Townsville South After School Care, please do not hesitate to contact Julian Douglas on 0428 065 544, or .

Thanks,

Julian Douglas

Coordinator - Townsville South State School After School Care

Children:

1. Name / Date Of Birth / / / / Male/Female
CRN / Medicare Number
School
Immunisation
Status
2. Name / Date Of Birth / / / / Male/Female
CRN / Medicare Number
School
Immunisation
Status
3. Name / Date Of Birth / / / / Male/Female
CRN / Medicare Number
School
Immunisation
Status

Child resides with: Mother Father Other (Please specify) .

Parent Details: Mother/Primary Carer

Name / Date of Birth
Address
Home Phone / Mobile
Place of Employment / Occupation
Work Phone / CRN
Email Address

Parent Details: Father/Primary Carer

Name / Date of Birth
Address
Home Phone / Mobile
Place of Employment / Occupation
Work Phone / CRN
Email Address

Emergency Contacts and Authority to collect

1. Name / Date of Birth
Address
Home Phone / Mobile
Relationship to Child
2. Name / Date of Birth
Address
Home Phone / Mobile
Relationship to Child
3. Name / Date of Birth
Address
Home Phone / Mobile
Relationship to Child

Child’s Medical Practitioner

Doctor’s Name.

AddressPhonePost Code .

Other Information(If asthmatic or anaphylactic, please attach a copy of the action plan to the back of this enrolment form)

Allergies/Conditions
Anaphylaxis/Asthma
Severity
Treatment
Cultural Background
Primary Language
Special Requirements

Court Orders

Please detail the nature of the court order below, and attach a copy to the back of this enrolment form.

Care Requirements: Permanent Booking Casual Booking

If you chose ‘Permanent Booking’, please write your child/children’s name in the are below and tick which day/s you require care. If you chose ‘Casual Booking’, please remember to let us by 2:30PM on the day when your child/children will be attending.

WEEK 1

Name / Monday / Tuesday / Wednesday / Thursday / Friday

WEEK 2

Name / Monday / Tuesday / Wednesday / Thursday / Friday

Please Read the information and tick the boxes below:

I/We agree to pay fees and charges as stated in the After School Care Pamphlet

I/We give permission for After School Care educators to seek medical attention in the event of illness or injury

I/We give permission for my child/children to be transported by ambulance or police in the case of emergency, associated costs to be covered by parents’guardians

The names of the people on this form are authorised to give permission to educators to escort children from the school grounds in an emergency or sign an excursion form

I/We agree to cover any costs incurred in seeking medical attention

The names of the people on this form are authorised to give permission for medication or medical treatment for the children listed on this form

I/We agree to contribute towards the cost and/or restoration of any property wilfully damaged by my child

I/We undertake to notify the service of any changes to the above information

I/We give permission for my child/children to be photographed for programming, evaluating and promotional purposes

I/We permission for my child/children to have sunscreen applied

I/We give permission for my child/children to have insect repellent applied

Parent/Primary Carer signature: Date: .

Please note that care will not be available until this form has been completed. Completed enrolment forms must be returned to the Townsville South After School Care Coordinator

For Staff:
Staff member has sighted any court orders, asthma, allergy, or anaphylaxis action plans, and immunisation records for the children listed on this form
Name: / Signature:
Date: