Out of School Hours Centre Inc
YATES AVENUE
OUT OF SCHOOL HOURS CENTRE INC.
ABN 55 940 284 155
2017 Enrolment form
Childs Details / Full Name: / Date of Birth:Childs CRN: / Gender: / Male / Female
Address:
Home Phone: / Place of Work:
Immunisation History Statementattached: / Yes / No
Note: It is a government requirement that we are required to hold a copy of the statement or a letter acknowledging that you choose not to have your child immunised.
Yates Avenue Public School / Grade:
Child's cultural background: / Languages spoken:
Parent / Guardian Details
Parent 1 / Full Name: / Relationship:Address:
Date of Birth: / Email Address:
Home Phone: / Mobile Phone:
Work Phone: / Place of Work:
Parents Reference Number:
Note: This is the number that Centerlink gives families who register with Family Assistance. It can be found on the letters you receive from Centerlink. It is located on the top left hand corner of the page it consists of 9 numbers and 1 letter.
Do you have any other children in CCB approved care? Y / N
If yes, how many children other than the child/ren you have enrolled at this centre do you have in CCB approved care? ______
Parent 2 / Full Name: / Relationship:Address:
Date of Birth: / Email Address:
Home Phone: / Mobile Phone:
Work Phone: / Place of Work:
Parents Reference Number:
Note: This is the number that Centerlink gives families who register with Family Assistance. It can be found on the letters you receive from Centerlink. It is located on the top left hand corner of the page it consists of 9 numbers and 1 letter.
Authorised collectors and emergency contacts:
Please list details of other persons authorised to collect the child and who can also becontacted in the case of an emergency when the Parents are unavailable.If no parent/carer can be contacted staff will contact one of those listed below. Photo identification will be required prior to release of the child. The person to be contacted must be at least 16 years of age.
Privacy Policy:This information is for the strict use of the Centre’s Staff, Management Committee and Administrators and will only be used for the purposes of administering the centre and caring for your child.
First Contact:
Name: ______
Address: ______
Relationship: ______Home Phone No: ______
Work Phone No: ______Mobile Phone No: ______
Authorised to collect student in parents absence: Yes / No Can be contacted for emergency purposes: Yes / No
Second Contact (if first unavailable)
Name: ______
Address: ______
Relationship: ______Home Phone No: ______
Work Phone No: ______Mobile Phone No: ______
Authorised to collect student in parents absence: Yes / No Can be contacted for emergency purposes: Yes / No
Permission Note:I hereby give permission for appropriate medical care and attention to be given for my child in the event of any accident or emergency as set out in the information booklet.
Signed: ______Date: ____/____/______
Permission Note:
In case of headache, fever or similar illness, I give permission for my child to receive Panadol (or similar paracetamol medication, such as Chemist Own brand - child’s formula and dosage) if deemed necessary by staff.
Signed: ______Date: ____/____/______
Medical information
Medicare Number ______Child Number: ___
Family Doctor’s Details:
Name: ______Ph: (0 )______
Address: ______
Asthma and Anaphylaxis
Is your child an asthmatic: Yes / No
If yes: Occasional /Mild / Heavy
If yes, please complete a management plan with staffto outline treatment needs
Does your child have any known allergies? Yes / No
if yes, please specify....
Note: An additional management plan needs to be completed with staff for all known allergies.
Has your child any health problems which you feel we should know about?
Is there any other information you feel the staff should be aware of, regarding the wellbeing of your child: (eg: vegetarian, family circumstances ... etc)
Permissions
The centre uses photos to document programmed activities and special events. These photos are displayed within the centre.
Permission for photos/ video to be taken of my child/ren? Yes/ No
Signature of Parent/Guardian______Date: ______
Permission of photos/ video of your child to be included:
In the school newsletter? Yes/ No
On the Yates Avenue OOSH Facebook page?Yes/ No
Signature of Parent/Guardian______Date: ______
Sunscreen is provided for the children. Our Sun-Safe policy states that hats must be worn during outdoors play.
Permission for my child/ren to wear sunscreen? Yes/No
Signature of Parent/Guardian______Date: ______
I understand that
I must give 2 weeks written notice to change or cancel bookings.
I must contact the centre if my child will be absent on a booked day.
If there is not a place available for my child/ren, my child/ren will be placed on a waiting list.
Signature of Parent/Guardian______Date: ______
It’s all about me
My name is: ……………………………………….……………………………………………………
I am ……….. years old
My favourite food is......
My favourite toy is……………….………………………………......
My favourite TV show is………………………...…………………………..………………………..
My favourite sport is…………………………………………………..………………………….
My best friend is……………………….………………………………..……......
When I am with my friends I like to…………………………………………………………......
......
When I am alone I like to……...... …………………..……………………………………………..
......
I feel safe when I am..……………………..……………………………......
......
I feel scared when I am………………………..………………………………......
......
When I grow up I want to be a…………………………..…………………………………………..
At the centre I hope we can…………………….……………………………......
......
If I could change 1 thing in the world I would………………….…………………………….
......
What else would you like the centre staff to know? Do you have pets, brothers or sisters or a talent?……………………………………………………………………………………………………….…………………………………………………………………………………………………………….…………………………………………………………………………………………………….
Yates Avenue Public School, King Street, DUNDAS VALLEY 2117. Ph 9804 7541. Email: