enrolmen t formfr.b5z.net/i/u/13035252/f/zig_and_zag_enrolment_form__2_.pdf · 2016. 4. 29. ·...

Appendix [Type text] [Type text] [Type text]

Appendix H Educators Zig and Zag

0

ENROLMEN

T FORM

Educators Zig and Zag

Contact Details

Address: 8 Ramsgate St Botany 2019

Phone: (02) 96664228

Email: [email protected]

Website: www.zigandzag.com.au

http://www.zigandzag.com.au/

Enrolment form Zig & Zag LDC

Reviewed 27th April 2016 1

Full Name of Child: _______________________________________ Sex F □ M □

Other Name by which the child is known: _______________________________________

Former Names of the child: __________________________________________________

Residential Address: ____________________________________ Postcode: __________

Residential Telephone: _________________________ E-mail: _________________________

Child’s Date of Birth: _____________________ Place of Birth: ___________________

Child’s Customer Reference Number as provided by the FAO: _______________________

Original birth certificate or certified copy provided/shown to Authorised Supervisor Yes □

Ethnic and cultural identity of the child: _________________________________________

Child’s Primary Language _______________

Proposed Commencement Date:____________

Copy of the child’s current immunisation record attached Yes □

Has your child attended another approved child care service in the current financial year?

Yes □ No □

Will your child attending this centre also attend another approved child care service?

Yes □ No □

Please indicate days and approximate times your child will attend this centre:

Estimated Start Time Estimated Pick Up Time

Monday

Tuesday

Wednesday

Thursday

Friday



EMERGENCY CONTACTS – PERSONS AUTHORISED TO COLLECT YOUR CHILD

Please provide details of emergency contacts in case parents cannot be reached and persons authorised

by parent to collect the child from the premises of the service. Must be 18 yrs old.

Person 1 Person 2

Full Name

Other names by which person

is known

Relationship to child

Home Phone Number

Work Phone Number

Mobile Phone Number

Other contact details

Authority to collect child? Yes □ No □ Yes □ No □

FAMILY COMPOSITION

Father Mother

Parents Full Name

Other name by which parent is known

Parent Customer Reference Number

as provided by Family Assistance Office

Date of birth

Residential Address



Home Phone Number

Mobile Phone Number

Place of employment

Address of employment

Work Phone Number

Other contact details

Any special requirements concerning the

child in relation to any disability?

If so please specify.

Any special requirements relating to your

child’s culture or religion?

If so please specify.

Any practice that you consider should be

observed at the service in respect of your

child’s religion or background?

Parents primary language

Any other languages spoken by parents

How many other children are there in your family? ______________________

Please supply following information for other children in your family:

Child’s Name Sex Date of Birth



GENERAL CONDITIONS

1. Zig & Zag Long Day Care Centre is open from Monday to Friday from 7:00 a.m. to 5:30 p.m.

excluding public holidays. The centre is closed during the Christmas period, parents are advised

of the exact dates of closure each year. No fees are payable for the Christmas closure period.

2. Fees must be paid 2 weeks in advance. Fees will be charged whether or not the child is in

attendance. Fees are charged for public holidays and each day that your child is booked into our

centre whether or not your child actually attends eg. days off due to sickness or holidays etc.

3. Please note you only receive CCB while your child attends the service, therefore if you give

notice to the service and do not attend up to the very last day of your enrolment you will not

receive CCB and need to pay full fees. This is a DEEWR regulation, if you would like more

information please contact Centrelink.

4. Fees are collected via Numeropro from your bank account each fortnight. If your fees fall

behind then your child’s place at the Child Care Centre may be up for review. Should your

payment be dishonoured for any reason you will be required to pay the amount outstanding

together with any charges incurred in recovering payment.

5. Children must be signed in and out of our centre by the parent or a person (over 18 years) who

is authorised by the parent.

6. If anyone other than the Parent or authorised persons as nominated on the enrolment form are

to collect the child from the centre, then one of the Parents must provide the centre with

authorisation (either written or verbal). This person must provide the staff with formal picture

identification (eg. drivers licence). The child will not be allowed to leave the centre with anyone

unauthorised to do so.

7. The centre closes at 5.30pm and every effort should be made to collect your child by 5.30pm. A

late fee of $20.00 will be charged for the first 10 minutes or part thereof and a further $10.00

for each subsequent 5 minutes or part thereof for children picked up after the scheduled closing

time of 5:30 p.m.. This fee is required to cover additional costs of running the centre after hours.

At least two staff are required to remain on the premises to care for any child at the centre.

Please remember that our staff also have commitments after 5.30pm.

8. If the child is absent from the centre for whatever reason the centre should be advised of the

absence at the earliest date/time.

9. It is important for parents to understand that children who become sick with any infectious



disease are required to produce a clearance certificate from their doctor before the child is

accepted back into this centre.

10. On leaving the centre parents are expected to give two weeks notice. Failure to do so will

result in two weeks fees being charged at full price.

11. Parents need to provide nutritional food and a piece of fruit each day that your child attends, A

cup or water bottle (for nursery) for drinking, sheets, formula and nappies if required.

12. The dates of birth and CRNs you give the service must be identical to the numbers on your FAO

record.

13. We understand that getting your child into quality child care is an important priority. Sometimes,

there may be a waiting list and to ensure the system is fair, the Australian Government has

‘Priority of Access Guidelines’.

Every approved child care service has to abide by the guidelines and tell you about them when you enrol

your child into care.

Priorities

Priority 1—a child at risk of serious abuse or neglect.

Priority 2—a child of a parent (or both parents if you have a partner) who satisfies the Government’s

work, training, study test.

Priority 3—any other child. Within these main categories priority should also be given to:

in families which include an individual whose adjusted taxable income does not exceed the

lower income threshold of $38 763 for 2010-2011, or who or whose partner is on income support

-English speaking background

n in socially isolated families

14. When receiving CCB you are responsible for keeping the Australian Government and Zig and Zag

LDC up-to-date and notifying them when your circumstances change.

Here is a checklist of responsibilities:

o provide your child care service/s with your Customer Reference Numbers, dates of birth and



Jobs, Education and Training Child Care fee assistance assessment notice,

o sign or initial attendance records daily to show when your child starts care (‘time in’) and

finishes care (‘time out’)—do not sign blank attendance records

o sign or initial attendance records each time your child is absent from care

o inform each child care service you are using when you have used your initial 42 absence days

(only if you receive CCB as a fee reduction) and provide your child care service with documents

where necessary for:

additional absence days your child is absent from care

an increase in the number of maximum hours you can get paid CCB

Special Child Care Benefit

advise the Family Assistance Office when changes happen that may affect your CCB. These

include when:

your child stops using child care

your child starts or leaves school

your and your partner’s income changes

you change partnering arrangements (opposite or same-sex) for example—if you get

married, registered, separated or divorced

your or your partner’s residence status changes

your address or bank account details change.

I acknowledge all the details I have provided are correct and accept the general conditions that apply

whilst my child is enrolled at Zig & Zag Long Day Care Centre.

Parents Signature: ______________________________

Print Name: ______________________________

Date: ______________________________



HEALTH

Family Doctor’s Name: __________________________________________________

Address: __________________________________________________

__________________________________________________

Telephone No.____________

Medicare Number by which the child is covered: __________________________________

Health Fund details: __________________________________________________________

Has your child ever had any serious illness or injury? Yes □ No □

If yes please specify _________________________________________________________

Has your child ever been hospitalized? Yes □ No □

If yes please specify _________________________________________________________

Does your child suffer from allergies, epilepsy, asthma or other specified medical conditions?

Yes □ No □

If yes please specify and advise of the treatment to be given if the child appears to be severely physically

affected by the condition while at the service:

___________________________________________________________________________

___________________________________________________________________________

Has your child ever experienced any language or speech difficulties, physical problems or other health

related issues: Yes □ No □ If yes please specify

___________________________________________________________________________

Some medications and topically applied creams or lotions can increase the skin’s sensitivity to UV

radiation. Parents are requested to check with their child’s doctor to determine if there is any risk from

any medications or creams that their child is using and advise the service in writing.

Is your child using any medications and/or creams or lotions which your child’s doctor has determined

to increase your child’s skin’s sensitivity to UV radiation: Yes □ No □

If yes please provide a letter from your child’s doctor.



Is there anything particular about your child that you feel this service should know about?

For example any allergies, disabilities, food tolerance etc. If so please specify:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

PLAY

How would you generally describe your child when playing at home?

Independent (Occupies and organises self) Yes □ No □

Dependant (Relies on adult) Yes □ No □

Active Yes □ No □

Quiet Yes □ No □

Do you have any additional comments __________________________________________

Does your child have any specific fears Yes □ No □

If yes do you wish to make any additional comments______________________________

_________________________________________________________________________

Are there any items that your child likes to carry for security’? Yes □ No □

If yes what are they? __________________________________________________________

Are there any words that have a special meaning for your child? If so please translate if

appropriate___________________________________________________________________________

Is there any further information that care-givers may need to know about your child?

__________________________________________________________________________

In order to assist us in your child’s development at this centre are there any particular issues that you

would like us to address in our program? If so please specify___________________

___________________________________________________________________________

Do you have any skills that you may wish to share that would contribute to programs conducted at the

centre? If yes please provide details: ________________________________



MEDICAL AUTHORISATION

I give my consent to the staff of Zig & Zag Long Day Care Centre, in the case of an emergency or either of

the parents are unavailable, to seek and carry out the appropriate urgent medical, hospital, dental

and/or ambulance service, which may include the administration of a local anaesthetic (if necessary) to

my child. Treatment may be sought at the following places:

• The nearest local hospital

• A local medical practitioner

I will accept responsibility for the payment of any costs involved in the treatment of my child.

Signed:________________________ Date: ___________________

Print Name: _____________________

PERMISSION TO ADMINISTER PARACETAMOL

In the event that your child has a high temperature (38 degrees or above) we may administer panadol in

order to control temperature. We will always endeavour to contact the parent first but should that

prove difficult we request your permission to give paracetamol (Panadol) to your child.

Do you give permission for your child to be given paracetamol if your child has a high temperature?

Yes □ No □ If no provide alternative ______________________

__________________________________________________________________________

Parent Signature: ________________________ Date: ___________________

Print Parent Name: _____________________



PERMISSION TO USE SUN BLOCK

During the warm weather we apply sunblock to the exposed areas of the children (face, neck, arms, legs

etc) . The sunblock is provided by the centre. We recommend that you apply sun block before your child

comes to our centre each day during warm weather.

Do you give permission for the centre’s sunblock to be used on your child when necessary?

Yes □ No □ If no, provide alternative __________________________________

Any further comments:__________________________________________________



PERMISSION TO PARTICIPATE IN ROUTINE FIRE DRILLS

Do you give your consent for your child to participate in routine fire drills while in attendance at the

service? Please note that such fire drills, on occasion may involve the children briefly leaving the

premises and walking to the safe assembly area located in the car park behind St Bernards church.

Yes □ No □

If no, provide alternative __________________________________

Any further comments:__________________________________________________





PERMISSION TO DISPLAY ARTWORK AND PHOTOGRAPHS

Do you give your consent to the staff of Zig & Zag LDC to display your child’s

artwork, Yes □ No □ and photos Yes □ No □ at the centre?

Do you give your consent for photos of your child to be published in the centre learning journey’s/ Story

Park and emailed to Zig and Zag LDC centre families only. Yes □ No □

Do you give your consent for photos of your child to be displayed on Zig and Zag centre public face book

site. Yes □ No □

I acknowledge the privacy required and I will adhere to keep all these photos and emails private and

confidential.





EXCURSION PERMISSION

Zig and Zag like the children to be involved with the community more to further their development and

awareness of the world around them. The centre is located very close to several beautiful parks and

playgrounds that the children can enjoy along with many other amenities.

We like to have ‘spontaneous’ excursions to some of the wonderful places our local area has to offer

such as Booralee Park, fellow daycares, fire station and shops. This means that should the weather

permit and we have children who are interested we would go for a walk to one of the above locations.

At times you may be notified of the plans via the notice board, email or Facebook page and at others

there may not be notice, hence referring to them as ‘spontaneous’ excursions.

These excursions would be handled in the same manner as any excursion. Before leaving the educators

will have done a risk assessment & road safety will be discussed along with what is expected of the

children while away from the centre, for example, listening to the educator, using manners, etc.

Educators will;

-Apply sunscreen and gather hats

-Discuss what we will be doing once we arrive at our destination

-First aid items will be taken

Zig and Zag’s expectations are for all children to join our excursions.

PLEASE SIGN YOUR PERMISSION BELOW

I, _________________, give my child, _____________________ permission to participate in regular

(spontaneous) excursions to local amenities such as Booralee Park, fellow daycares, corner shops and

walks around the block to further their physical, social skills and community awareness. I acknowledge

that I may not be notified of this excursion prior to it taking place.

Signature: _____________________________ Date: _________



DIRECTIONS FOR ACCESS

I hereby direct the staff of Zig & Zag Long Day Care Centre to deny access to my child

_________________________________ (insert child’s name) by the following people:

Name: 1. ________________________________________________

Address_______________________________________________________________

+

Name: 2. _______________________________________________

Address_______________________________________________________________



ADVICE ON COURT ORDERS AFFECTING ACCESS TO CHILD

I hereby undertake to advise Zig & Zag Long Day Care Centre of the details of any court order affecting

custody of my child.

Please note: Court orders need to be verified by the Nominated Supervisor or Approved Provider by

inspection of duly certified copy of the court order at the time of enrolment at the service or after the

making of any subsequent court order.





FIRST AID PRODUCTS AVAILABLE AT THE CENTRE

Child’s Name ___________________________________ D.O.B._________________

The following first-aid products are contained in our centre’s first-aid kit.

Please cross out and initial any product/s that you will not allow to be applied to your child.

Product Brand Cross out & Initial if

not allowed

Children’s Panadol, Baby Drops 1mth-2yrs Smith Kline Beecham

Children’s Panadol, Elixir/Suspension 1-5

yrs

Smith Kline Beecham

Betadine Antiseptic Liquid Faulding Pharmaceuticals

Dettol Antiseptic Cream Reckitt & Colman

Papaw Ointment Lucas Papaw Remedies

Savlon Cream Reckitt & Colman

Stingoes Gel, for stings and bites Pfizer

Vaseline White Petroleum Jelly Unilever

Plastic strips (band-aids) Johnson & Johnson/First Aiders

Steristrip 3M

Medi-swabs Smith & Nephew/Briemarpak

Gelflex Sterile Saline/Sodium Chloride

Irrigation Solution

Tyco Healthcare/Pfizer



I agree that the above products, other than those deleted, may be applied to my child as basic first-aid

treatment.

PLEASE NOTE THAT NO OVER THE COUNTER MEDICATIONS (eg Dimetapp etc.) WILL BE GIVEN TO

CHILDREN UNLESS PRESCRIBED BY A MEDICAL PRACTITIONER AND ARE CLEARLY LABELLED WITH THE

CHILD’S NAME & DOSAGE DETAILS ON AN AUTHORISED PRESCRIPTION LABEL.

A ‘Record of Medication Administered’ form must be completed for each product that you wish to be

applied or given to your child, eg. Nappy rash ointments/creams, powders etc.

Forms are available in the sign in area.

Parent Signature: ______________________________ Dated: ____________________

Print Parent Name: _____________________________

Reviewed by: Leah Micallef (Approved Provider)

Signed: ______________________________ Dated: ____________________



We look forward to caring for your child at Zig & Zag Long Day Care Centre. If you

have any suggestions that you would like to put forward, please feel free to

approach any of our staff. We also suggest that you approach us if you have any

concerns about the service we are providing. We welcome parent participation in

many areas of the centre’s operation, and look forward to a warm and trusting

relationship with you and your child.

Regards,

Zig and Zag LDC Management

enrolmen t formfr.b5z.net/i/u/13035252/f/zig_and_zag_enrolment_form__2_.pdf · 2016. 4. 29. ·...

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