A journey of a thousand miles begins with a single step.

- Lao-tzu -  

Enrolment Form Child’s Details

Full Name:………………………………………………………………… Date of Birth: …..… /…..…/………….….

Male ☐ Female ☐ Ethnicity:……………………………… Iwi (if applicable)…………………………….

Home Address:……………………………………………………………………………………………………………………………..

Parent or Guardian’s Details

Name:.………………………………………………………. Name:.……………………………………………………………. Mother or guardian first name & surname Father or guardian first name & surname

Home Phone:……………………………………………….. Home Phone:.…………………………………………………....

Mobile/Business Phone:…………………………............... Mobile/Business Phone:.…………………………....................

Occupation:………………………………………………….. Occupation:……………………………………………………….

Email:………………………………………………………… Email:………………………………………………………………

Custody Details:……………………………………………………………………………………………………………………………. If applicable, please advise of any custody orders to be observed (documents will be required at time of commencement).

Is there anyone who is forbidden by law to have access to your child?......................................................................................

Persons authorized to collect my child: 1………………………….… 2………………….………….. 3……………………………..

Emergency Contact Details

Child’s Doctor:………………………………………… Phone:……………… Address:…………………………………….................

Medical Information, e.g. allergies, chronic conditions (include details, action plan)……………………………………………………

Immunisations to date (if so, bring verification)……………………………………………………………………………………………..

Comments……………………………………………………………………………………………………………………………………

Emergency Contact (when Parents/Guardians uncontactable):…………………………………………………………………. Application Details

Preferred enrolment start date: …… /……/………… From the table below, please indicate your preferred days of attendance—We accept enrolments for two or more sessions.

20 Hours ECE Attestation

1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Y / N 2. Is your child receiving 20 Hours ECE at any other services? Y / N

If yes to either or both, please sign to confirm that:……………………………………………………………………………………. • Your child does not receive more than 20 Hours ECE per week across all services. • You authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Form, if

deemed necessary to make decisions about your child’s eligibility for 20 Hours ECE. • You consent to Little Engines providing relevant information to the Ministry of Education about the information provided

here.

Days 8.30am-3.30pm Monday Tuesday Wednesday Thursday Friday

Terms & Conditions of Enrolment Eligibility & Fees I confirm that at the time of enrolment my child will be over two years of age. I agree to pay the Little Engines fees on the basis of the current Little Engines fees schedule and agree to pay such fees fortnightly in advance. If I am unable to meet this obligation, I will notify the Manager immediately and pay the 5% late payment penalty. I understand that all fees must be paid by way of direct credit or cheque only. I acknowledge and agree to pay the fees for all enrolled sessions even if my child is unable to attend due to sickness, holidays, or statutory holidays. I am aware that Little Engines is closed for 2 weeks at Christmas time (end Dec and beginning Jan) when fees are not payable. I understand and accept that irrespective of any arrangement I may make with any third party to pay the fees (e.g. Income Support Services, Trusts etc), the full responsibility to pay the Little Engines fees remains with me. I understand and accept that if any fee remains unpaid, beyond the time specified above, my child’s enrolment may be forfeited and the debt passed on to a Debt Collection Agency for collection. I accept responsibility for any costs incurred in this process. Notice of change to enrolment or Withdrawal I agree to give 30 days written notice to The Manager and pay the full fees payable prior to changing my child’s enrolment or withdrawing my child from Little Engines. Y / N I understand that: • The 30 days notice is taken from the date my letter is received by Little Engines. • Little Engines management will, on receiving my letter, notify me of my child's final enrolled session.

Use of and Updating Information I shall notify Little Engines of any change in the information contained in the Application for Enrolment and/or the Acceptance of Enrolment as soon as is reasonably practical. I agree to complete the Confirmation of Enrolment form each time my child’s enrolment is altered. I give permission for my child to be photographed for documentation, advertising, and newsletters. I give permission for personal information on this application to be used in the event of an emergency, for Ministry of Education audits, or as required by law. I agree for my child’s name and phone number to be included on the Little Engines Montessori List available to all parents with currently enrolled children at the pre-school. Y / N Arrival and Departure During my child’s enrolment at Little Engines, I will sign the daily register on arrival and departure and advise my child’s teacher of their arrival and departure accordingly. I have observed the designated start and finish times of each session and shall deliver and collect my child on time. I will call the staff at Little Engines if I am unavoidably late and I acknowledge that a late collection fee of $10.00 applies on each occasion that my child is collected more than 10 minutes after the designated time. I understand that my child cannot be delivered or collected from Little Engines by persons under 16 years of age. If my child is to be collected by someone not previously nominated, I will advise Little Engines staff prior to collection. Your child will not be released if there is clear reason to suspect that the adult picking up is under the influence of drugs or alcohol. Illness & Absence I agree not to bring my child to Little Engines if they are unwell or suffering from any condition that is contagious - details of which are in the Little Engines Parent Handbook. I will advise Little Engines staff promptly of my child’s absence and inform them of the nature of the illness. I authorise Little Engines staff to administer medication provided by me for my child and in the event of illness or accident to conduct first aid and/or seek medical advice as the pre-school deems necessary for my child’s best interest. I give permission for Little Engines teachers to administer Pamol for fevers and homeopathic arnica drops and/or apply arnica cream for my child as required. In the event of an emergency, I authorise Little Engines staff to seek professional medical assistance or treatment as they deem necessary. I will incur the cost of any such extra services. Y / N I agree to issue advance notice if my child will not be attending Little Engines for reasons other than illness. Y / N Custody Arrangements If a parent is denied access to their child, Little Engines must have a copy of the Custody Order in order to deny access to the child. If we do not have a copy of the Custody Order we are obliged to release the child to the parent. Outing Authority I acknowledge that all outings in a vehicle will require separate consent and an individual form will be prepared by Little Engines for me to sign prior to the excursion. I give permission for my child to participate in spontaneous trips (e.g. short walks) and acknowledge that the adult:child ratio will be at least at the minimum required by Little Engines on these excursions. Y / N The Little Engines Policies & Practices I agree to abide by the Little Engines Policies and Practices, as set down by management. I understand that these terms and conditions are not exhaustive and that others are contained in published Little Engines documents made available via newsletter, in the Parent Handbook, on the Little Engines website and the pre-school notice board located in the entrance foyer. I accept that Little Engines reserves the right to add, amend, clarify or delete terms, conditions or policies by issuing newsletters, notices and/or by displaying notification on the pre-school cloakroom notice board and/or on the Little Engines website. Notification to Caregivers If someone else e.g. nanny, friend or relative is caring for and delivering my child to Little Engines, I will ensure that they read and understand these terms and conditions. Application Declaration

I have read, understood and agree to the Little Engines Terms and Conditions.

Full Name:…………………………………………………………………………………………………………

Signed:…………………………………………….. Date: …..… /…..…/……………..

OFFICE USE ONLY: Date enrolment received …..../…..../……...….. Staff …………………………………….