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Enrolment Form PDF

This document contains an enrolment form for a child to attend Small Friends daycare. It requests information such as the child's name, date of birth, home address, emergency contacts, medical details, dietary requirements, and languages spoken at home. The form also provides information on the centre's policies regarding illness, media permission, incursions and outings, and non-payment of fees. The parent or guardian signs the form to acknowledge the policies and provide authorisation for medical treatment in an emergency.

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ourpatch
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177 views2 pages

Enrolment Form PDF

This document contains an enrolment form for a child to attend Small Friends daycare. It requests information such as the child's name, date of birth, home address, emergency contacts, medical details, dietary requirements, and languages spoken at home. The form also provides information on the centre's policies regarding illness, media permission, incursions and outings, and non-payment of fees. The parent or guardian signs the form to acknowledge the policies and provide authorisation for medical treatment in an emergency.

Uploaded by

ourpatch
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ENROLMENT

Date of Enrolment
Sessions Requested

Monday

AM

PM

FD

Tuesday

AM

PM

FD

Wednesday

AM

PM

FD

Thursday

AM

PM

FD

Friday

AM

PM

FD

Office only

Returning Family
Record

CHILD

Notes

COPIES OF

DDR collected

Birth Certificate

Immunisation Record

Full Name

Male

Female

CRN

Date of Birth

Address

Postcode

PRIMARY PARENT/GUARDIAN
Full Name
Address

As above

Home Phone

CRN

Date of Birth

Work Phone

Postcode

Mobile

Send all communication to this address.

Email
Place of Employment

SECONDARY PARENT/GUARDIAN
Full name
Address

CRN

Date of Birth

As above

Home Phone

Work Phone

Postcode

Mobile

Send all communication to this address.

Email
Place of Employment

AUTHORISED PERSON FOR DROP OFF COLLECTION EMERGENCY CONTACT

Full Name

Drop off

Collect

Address
Home Phone
Relationship to Child

Emergency Contact
Postcode

Work Phone

Grandparent

Aunt/Uncle

Mobile

Friend

Sister /Brother

Other :

AUTHORISED PERSON FOR DROP OFF COLLECTION EMERGENCY CONTACT

Full Name

Collect

Drop off

Address

Postcode

Home Phone
Relationship to Child

Emergency Contact

Work Phone

Grandparent

Aunt/Uncle

Mobile

Sister /Brother

Friend

Other :

AUTHORISED PERSON FOR DROP OFF COLLECTION EMERGENCY CONTACT

Full Name

Drop off

Collect

Address
Home Phone
Relationship to Child

Emergency Contact
Postcode

Work Phone

Grandparent

Aunt/Uncle

Mobile

Sister /Brother

Friend

Other :

DETAILS OF GUARDIANSHIP AND CUSTODY INCLUDING TERMS OF ANY SPECIFIC CUSTODY OR ACCESS PROVISION

MEDICAL INFORMATION
Childs Doctor

Medical Centre/Surgery

Address

Phone

Medicare Number

Health Insurance Fund


I hereby give my permission to Small Friends to call medical advice in the case of an emergency and agree to
..pay any expenses incurred for medical treatment and transport.

Authorisation
Signed

Name

Date

INFORMATION RELEVANT TO THE SAFETY AND CARE OF CHILD


Immunisations

A copy of your childs immunisation record will be kept on file at Small Friends.

Is your child fully immunised?

Yes

No

Has your child been diagnosed with any of the following :

Yes No
Yes No

German Measles
Whopping Cough

Measles
Chicken Pox

Allergies

Yes

No

Notes

Requires Regular Medication


and/ or Medical Attention

Yes

No

Notes

Asthma or Recurrent Chest Infections

Yes

No

Notes

Seizures

Yes

No

Notes

Premature Baby

Yes

No

Notes

Skin Problems

Yes

No

Notes

Eyesight Problems

Yes

No

Notes

Other Chronic Health Conditions

Yes

No

Notes

Yes No
Yes No

Mumps

Yes

No

Other :

Previous Illnesses or Operations

SPECIAL CARE NEEDS

DIETARY NEEDS

CULTURAL OR RELIGIOUS NEEDS

OTHER INFORMATION
Languages Spoken at Home
Brothers and/or Sisters Names
Other Relevant Information

NOTES AND DECLARATION


Illness

A child cannot be accepted into our care with any illness, which may in any way be transferred to others.

Media Permission

You will need to inform us in writing if you do not wish for Small Friends to publish photos or videos of your child.

Incursions and Outings


..

We encourage members of the community to visit us for incursions, linking in with our programed themes.
When an external outing is planned you will need to attend with your child.

Non Payment of Account If payments fall behind by 1 week you will have until the following charge day to pay the account in full. If monies
are still outstanding after 3 weeks your childs enrolment will cease, and debt collection procedures will be put in place by Small Friends.

Signed by Parent or Guardian

Date

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