Re-enrolment-form – Yarram ELC

- Step 1 of 4

Information about your child

Name *

First

Last

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

Have you recently changed your address? *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Child Care Subsidy Information

Please note it is the parent/guardian’s responsibility to apply for CCS. You may need to make a new claim with Centrelink. 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 for YELC to use your child/ren 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 Centre supplied nappies and wipes at an additional cost of $4.00 per day
No, I will bring my own nappies and wipes
N/A

At YELC we use nappy cream, kids SPF50+ sunscreen and insect repellent. If you would like to supply your own nappy rash cream, sunscreen or repellent, please tick below. *

I will bring my own nappy rash cream
I will bring my own sunscreen
I will bring my own insect repellent
N/A

Which days would you prefer/require your child to attend? *

Monday
Tuesday
Wednesday
Thursday
Friday

Please add any additional notes regarding the days you wish your child to attend.

Parent/Guardian 1

Parent/guardian 1 is the parent listed with Centrelink to recieve Child Care Subsidy

Name *

First

Last

Date of Birth *

Have you recently changed your address? *

Yes
No
Yes, same as child's

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Have you recently changed your email contact? *

Email *

Have you recently changed your contact number? *

Contact number *

Have you recently changed your employment? *

Employer name

Employer contact number

Employer location/suburb

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

Have you recently changed your address? *

Yes
No
Yes, same as child's

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Have you recently changed your email contact? *

Email *

Have you recently changed you contact number? *

Contact Number *

Have you recently changed your employment? *

Employer name

Employer Contact number

Employer location/suburb

Emergency Contacts

Not including parents/guardians

Your current emergency contacts will remain as they are for the following year unless you select from one of the below options:

Would you like to remove any of your current Emergency Contacts? *

*Please note the emergency contact will be notified automatically by Xplor when they have been removed.*

Who would you like to remove *

Would you like to add any additional Emergency Contacts? *

Emergency Contact 1

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number: Mobile *

Email *

Contact Number: Work

Relationship to child *

Authority *

Authority to collect the child
Notiify 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

Would you like to add another emergency contact? *

Emergency Contact 2

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number: Mobile *

Email *

Contact Number: Work

Relationship to 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

Would you like to add another emergency contact? *

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Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number: Mobile *

Email *

Contact Number: Work

Relationship to 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

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? *

Bring the ORIGINAL court order/s for staff to see and a copy for the centre IF the court 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 contact with a parent or other person.

File Upload

Click or drag a file to this area to upload.

Has your child been immunised? *

Yes: Please provide the details by uploading or attaching 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 Australian Childhood Immunisation Register (ACIR) by: Phone: 1800 635 809. EMAIL: [email protected]. VISIT: www.medicareaustralia.gov.au/omline. It can also be accessed via MYGOV or by visiting a Medicare service centre. Other forms of Immunisation documentation cannot be accepted.
No: Please upload or attach a certification that your child is on a catch-up schedule or certification of a 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.

Upload Immunisation History Statement *

Click or drag a file to this area to upload.

Health Information

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

Please provide details below *

Paracetamol

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. *

Have your medical practitioner/GP details changed? *

GP/Clinic Name *

GP/Clinic Number *

GP/Clinic Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Medical Conditions

Has your child had any change to their medical condition within the last 6 months? *

Please provide details of medical conditions *

PLEASE NOTE: IF YOUR CHILD HAS ANY OF THE FOLLOWING CONDITIONS, YOU WILL NEED A RISK MANAGEMENT PLAN FROM YOUR GP.

Asthma, Eczema, Anaphylaxis/Allergies, Epilepsy, Diabetes, Coeliac.

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

Please provide details of special requirements *

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

Please provide details *

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

Please read and understand the following conditions 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 and Parent 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 Learning 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 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 Procedures 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 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 the above conditions *

Approve (Parent/guardian1)
Approve (Parent/guardian 2)

Date *

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