Enrolment Form – Yarram ELC

– Step 1 of 6

Information about your child

Name *

First

Last

Preferred name (the name you wish your child to be called)

Date of birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Medicare Number

Country of Birth *

Cultural background *

Languages spoken at home *

Is your child of Aboriginal or Torres Strait Islander origin? *

No, not Aboriginal or Torres Strait Islander
Yes, Aboriginal and Torres Strait Islander
Yes, Aboriginal
Yes, Torres Strait Islander

Has your family or child had a refugee experience? *

Child Care Subsidy (CCS) information

Please login to MYGOV and apply for Child Care Subsidy before commencing care. If you do not have a MYGOV account you will need to apply for an account via the website: www.my.gov.au You will be given a reference number (CRN) for yourself and your child. Please list these details below.

Child Customer Reference number *

Parent/Guardian Customer Reference number *

PLEASE NOTE: It is the parent/guardians responsibility to apply for CCS. Until you have completed your CCS application and informed Centrelink that you will be using care you will be liable for paying full fees.

Photo Consent

On a daily basis the educators at YELC take photos of your child/ren and we are often using these photos for learning observations, social media, promotional material and external news outlets. Please indicate below your consent below with a tick or cross for YELC to use your child's photo. *

Internal/Private: Lock tags, personal Xplor learning observations sent only to us
Xplor Group: Photo is included in group observations that are sent to other parents
Online: Social media and website
External: Newspaper (Please note the newspaper is posted on social media)

Supplied by the centre

Nappies *

Yes, I will use the Centre supplied nappies and wipes at an additional cost of $3.00 per day.
No, I will bring my own nappies and wipes.
N/A

At YELC we use nappy cream, Aeroguard pump spray insect repellent and Kids SPF50+ sunscreen. If you would like to supply your own nappy cream or sunscreen please tick below.

I will bring my own sunscreen
I will bring my own nappy rash cream
I will bring my own insect repellent

Parent/Guardian 1

Parent/guardian 1 is the parent listed with centrelink to receive Child Care Subsidy

Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Relationship to the child *

Email *

Contact Number: Mobile *

Contact Number: Work

Are you? *

Working
Studying
Training
Other

Please list below the organisation where you work, study or train

Occupation *

Cultural Background *

Does the child live with parent/guardian 1? *

Parent/Guardian 2

Completing this section gives this person full authorities for the child. *Authority to collect, *Authority to be contacted in an emergency, *Authority to be contacted to give permission to administer medication, *Authority to be contacted to give permission for transport, *Authority to be contacted to give permission to go on excursions. If you DO NOT wish for this person to have any authorities please enter Parent/Guardian 1 again.

Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Relationship to the child *

Email *

Contact Number: Mobile *

Contact Number: Work

Are you? *

Working
Studying
Training
Other

Please list below the organisation where you work, study or train

Occupation *

Cultural Background *

Does the child live with parent/guardian 2? *

Emergency Contacts

Not including parents/guardians

EMERGENCY CONTACT 1 : Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number: Mobile *

Contact Number: Work

Relationship to the child *

Authority *

Authority to collect the child
Notify of an emergency, any accident, injury, trauma or illness involving the child
Authority to consent to medical treatment/ administration of medication
Authority to consent to excursions
Authority to consent to transportation

EMERGENCY CONTACT 2 : Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number: Mobile *

Contact Number: Work

Relationship to the child *

Authority *

Authority to collect the child
Notify of an emergency involving the child
Authority to consent to medical treatment/ administration of medication
Authority to consent to excursions
Authority to consent to transportation

Do you require additional emergency contacts? *

EMERGENCY CONTACT 3 : *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number: Mobile *

Contact Number: Work

Relationship to the child: *

Authority: *

Authority to collect the child
Notify of an emergency involving the child
Authority to consent to medical treatment/ administration of medication
Authority to consent to excursions
Authority to consent to transportation

Court orders relating to the child

Are there any intervention orders, protection orders or any parenting plans/parenting orders relating to the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child? *

YES – Please complete the following
NO – go to the next section

Bring the ORIGINAL court order/s for staff to see and a copy for the centre IF the orders: A) Change the powers of a parent/guardian to: Authorise the taking of the child outside the service by a staff member of the service, consent to the medical treatment of a child, Request or permit the administration of medical treatment of the child, request or permit the administration of medication to the child, collect the child from the service. AND/OR, B) Give these powers to someone else. C) Relate to the child's residence or the child's contact with a parent or other person.

Please describe these changes and provide the contact details of any person given these powers.

Immunisation Record

Has your child been immunised? *

YES: Please provide the details by uploading your child’s Australian Immunisation Register: Immunisation History Statement PLEASE NOTE: YOUR CHILD CANNOT ATTEND THE CENTRE UNTIL DOCUMENTATION IS RECEIVED. This can be obtained from the Australia Childhood Immunisation Register (ACIR) by: Phone: 1800 635 809 Email: [email protected] Visit: www.medicareaustralia.gov.au/online Can be accessed via MYGOV, or visit a Medicare Service Centre.. Other forms of immunisation documentation cannot be accepted
NO: Please upload a certification that your child is on a catch-up schedule OR certification of medical reason not to be vaccinated. If you cannot supply this certification then your child’s enrolment cannot be accepted.

‘No jab, No play’ Is the legislation that requires all children to be fully vaccinated unless they have a medical exemption to be enrolled in childcare or kindergarten in Victoria AND Other forms of immunisation documentation cannot be accepted.

Immunisation History Statement OR Medical Certificate *

Click or drag a file to this area to upload.

Birth certificate

Please upload a copy of your child's birth certificate. *

Click or drag a file to this area to upload.

NOTE: If you are enrolling into Kindergarten, your child cannot commence Kindergarten until a copy of their birth certificate has been provided

Health information

Has your child attended a Maternal and Child Health centre for a Health and Development assessment? *

Do you have your MCHN have any developmental concerns for your child? *

If YES, please provide details below

Has your child seen or is currently seeing an Occupational Therapist, Speech Therapist, Paediatrician, Optometrist or other? *

If YES, please provide details below

Should i/we or the emergency contacts be unreachable, i/we give permission for staff of Yarram Early Learning Centre to administer Paracetamol if my child reaches a temperature at or above 38 degrees. *

General practitioner GP details

GP/Clinic name and Number *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Medical conditions

Does your child have any medical conditions and needs? E.g. epilepsy, diabetes, asthma, anaphylaxis, eczema, coeliac disease etc. *

Asthma
Anaphylaxis/Allergies
Diabetes
Eczema
Epilepsy
Coeliac
OTHER
NONE

If yes for any of the above, you will need a risk management plan from your GP. NOTE: A link for each risk management plan is listed below. The Centre will need a hard copy of this once filled out by your GP.

https://www.allergy.org.au/images/stories/anaphylaxis/2020/ASCIA_Action_Plan_Anaphylaxis_Generic_Red_2020.pdf

https://www.diabetesvic.org.au/Advanced-Search-Result-Detail?ocmsLang=en_US&content_id=a1R0o00000JkhI4EAJ

http://92c.a0a.myftpupload.com/wp-content/uploads/2020/06/Coeliac-Action-Plan.pdf

https://epilepsyfoundation.org.au/wp-content/uploads/2019/09/EMP-Seizure-x-2-unrestricted.pdf

https://www.allergy.org.au/patients/skin-allergy/eczema-action-plan

Other information

Does your child have any special requirements i.e. cultural, religious, dietary or additional needs?

If YES, please list these requirements below.

If there is anything else that we should know about the child? (e.g. excessive fears, favourite activities, attending other early childhood service or early intervention service, etc.)

Privacy

The personal information requested on this form is being collected for the purpose of enrolling your child with Yarram Early Learning Incorporated. The personal information will be used solely for that primary purpose or directly related purposes. We may disclose some of this information to the Department of Education and Early Childhood Development under the Children’s Services Regulations. If this information is not collected we will be unable to process your application. The applicant understands that the personal information provided is to assist in the placement of their child and that he or she can have access to make appropriate amendments to the information. This form must be completed by a parent or guardian who has lawful authority in relation to the child. Enrolment forms must be completed in full prior to commencement. The form is checked and approved by the services supervisor. Commencement into the service may be delayed due to incomplete information (Children’s Services Law in Section 5 of the Education and Care Service National law (Victoria) the Children’s Services Act 1996 and the Regulations 160 – 162, under the Act).

Enrolment Agreement

I Parent/guardian 1: *

1 Parent/guardian 2:

Please read the following conditions understanding of the following condition and expectations and sign below.

Agree to abide by the YELC (Yarram Early Learning Centre) standards of conduct, as set out in the Code of Conduct Policy while at the service.
Declare that the information in this enrolment form is true and correct and agree to provide all changes to this enrolment form in writing without delay
Agree to collect or make arrangements for the collection of the child referred to in this enrolment form if she/he becomes unwell at the service.
Agree to Yarram Early Leaning educators administering first aid when required. This includes but is not limited to band aids and saline eye wash.
Agree to Yarram Early Learning educators applying CANCER COUNCIL KIDS 50+ sunscreen as per Centre SunSmart Policy. If my child requires an alternative sunscreen then I/we will supply it to the centre.
Agree to Yarram Early Learning educators applying CURASH nappy cream when required. If my child requires an alternative nappy cream then I/we will supply it to the centre.
Agree to Yarram Early Learning educators checking my child’s hair for head lice to minimise the spread of cross infection in the Centre.
Agree to Yarram Early Learning educators seeking medical treatment from a medical practitioner and/or arranging ambulance transportation to a hospital the case of an emergency in accordance with our Administration First Aid Policy and agree that I am liable for all expenses incurred in arranging such emergency service.
Agree to inform YELC of all medical needs and requirements of my child/ren. This includes information of any medical condition, any medication required to be administered and any medication or other substances which should not be provided or administered to a child.
Agree that the ongoing management of the child/ren’s medical condition, if any, remains my sole responsibility and is not and does not under any circumstances become the responsibility of the children’s services educators.
Agree that, in the event of any adverse reaction by the child to the administration of medication which I have authorised or in the event that any action or inaction on the part of children’s services educators results in any aggravation, exacerbation, acceleration or deterioration of any medical condition suffered by the child. I release and indemnify the educators at Yarram Early Learning Centre from all actions, suits and claims of any nature, I or my child may have relating to the administration of medication or the failure to administer medication or any action or failure to act related to any medical condition identified in this Child Action Plan.
Give permission for staff of Yarram Early Learning Centre to take my child on incidental excursions out of the Service premises to the Library and Community Room with the permission of the Centre Director or person in charge and in accordance with Education and Care Services Regulations 2011. NOTE: Parents/guardians will be notified and a separate permission form provided for any other special excursions which may occur during the year.
Agree to inform the service if my child contracts any illness/infectious disease which could be detrimental to health of others at the program.
Accept full responsibility for my children’s belongings whilst taking part in the program.
Understand that the YELC Policies and Procedure are available to view in the YELC foyer and online and agree to abide by them, including all aspects of the fee policy.
Acknowledge that there may be times when my child’s full name will be displayed at the service. If I have concerns about this issue I will advise the service in writing.
Agree to pay for all the days my child is successfully enrolled, regardless of whether my child actually attends the session, within fourteen (14) days of receiving my account, and accept that my care may be cancelled if I do not adhere to this agreement
Agree to Yarram Early Learning providing food for my child for special occasions. During the course of the year there are times when the centre will offer food to the children. Sometimes this can be a part of the program as a cooking experience, or fresh food experience. Other times it may be for celebration days, like birthdays or picnics in the park. Any food offered will take into account any allergies or cultural requirements as listed in your child’s enrolment form.
Agree for my child to view G or PG movies that link in with the program. Parents will be informed on the Program of any upcoming movies and if you have any concerns about a particular movie you can discuss this with the room educators or Director
Agree for my child to view educational videos including short films and documentaries that form part of the educational program.

I (parent/guardian) acknowledge and understand of the above conditions *

Approve (Parent/guardian 1)
Approve (Parent/guardian 2)

Date *

File Upload

Click or drag a file to this area to upload.

Email *

File Upload

Click or drag a file to this area to upload.

Email *

Website