quirky kids reg_ second logo · web viewthe parent(s) / guardian agrees that in an emergency...

QUIRKY KIDSAFTERCARE & HOLIDAY CARE

REG # 2019/335296/07082 457 6295 / 071 118 [email protected] PW FERREIRA STREET

MALANSHOFRANDBURG

REGISTRATION FORM

1. PERSONAL DETAILS:

DETAILS PERTAINING TO THE CHILD (please print clearly)

SURNAME

FIRST NAME

DATE OF BIRTH

HOME LANGUAGE

SECOND LANGUAGE

CURRENT SCHOOL ATTENDING:(if applicable)

GRADE

DATES ATTENDED AT PREVIOUS /CURRENT AFTERCARE(if applicable)REASON FOR LEAVING PREVIOUS / CURRENT AFTERCARE(if applicable)PRINCIPAL OF PREVIOUS / CURRENT AFTERCAREPREVIOUS / CURRENT AFTERCARE TELEPHONE NUMBER

Is your child fluent in ENGLISH? YES / NO (please circle)

If “NO”, please explain: _

________________________________________________________________________________________

I/WE ACKNOWLEDGE THAT THIS REGISTRATION FORM WILL BE TREATED AS CONFIDENTIAL AND ALL INFORMATION PROVIDED IS TRUE AND CORRECT.

MOTHER – PRINT NAME ____________________ SIGNATURE: _________________ DATE SIGNED: ___________

FATHER – PRINT NAME ____________________ SIGNATURE: _________________ DATE SIGNED: ___________

GUARDIAN– PRINT NAME ____________________ SIGNATURE: _________________ DATE SIGNED: ___________

5. LEGAL GUARDIAN(S) CONTACT DETAILS:

DETAILS PERTAINING TO THE GUARDIAN (please print clearly)

SURNAME:

FIRST NAME;

HOME TELEPHONE.

WORK TELEPHONE

CELLPHONE NUMBER:

EMAIL ADDRESS:

IDENTITY f PASSPORT NUMBER:

MARITAL STATUS: SINGLE MARRIED DIVORCED SEPARATED

OTHER (please specify)

RELATIONSHIP TO CHILD:

6. OPERATING TIMES:

6.1 Quirky Kids is open from 07h00 until 18h00 five {5) days a week (Monday to Friday).

6.2 Children have to be collected by 12h00 (half-day) and 18h00 (full-day).

6.3 Any late collections will result in a fine of R 50.00 for every thirty (30) minutes late after

12h00 for half-day children and after 18h00 for full-day children.

6.4 Any calls made to parents regarding collection during this period will be charged at R 30.00 per call.

7. HOLIDAYS:QUIRKY KIDS AFTERCARE7.1 will be closed on all Public Holidays; and one week during either April or July annually – to be

announced.

7.2 will be open during Government school term holidays;

7.3 will officially close annually during the December/January period;

7.4 the dosing period is between three (3) to four (4) weeks;

7.5 the closing period dates will be advised annually towards year-end.





4: PARENTS CONTACT DETAILS:

DETAILS PERTAINING TO THE MOTHER (please print clearly)

SURNAME:

FIRST NAME

HOME TELEPHONE:

WORK TELEPHONE:

CELLPHONE NUMBER:

EMAIL ADDRESS

IDENTITY / PASSPORT NUMBER.

MARITAL STATUS SINGLE MARRIED DIVORCED SEPARATED


IF SINGLE. ARE MOTHER AND FATHER LIVING TOGETHER?

YES NO

DETAILS PERTAINING TO THE FATHER (please print clearly)

SURNAME:

FIRST NAME

HOME TELEPHONE:

WORK TELEPHONE:

CELLPHONE NUMBER:

EMAIL ADDRESS

IDENTITY / PASSPORT NUMBER.

MARITAL STATUS SINGLE MARRIED DIVORCED SEPARATED


IF SINGLE. ARE MOTHER AND FATHER LIVING TOGETHER?

YES NO





2. REGISTRATION / ENROLMENT REQUIREMENTS:

Please indicate your requirement below:

□ SCHOOL TERM AFTERCARE (inclusive of school holidays)

□ SCHOOL TERM AFTERCARE (exclusive of school holidays)

□ CASUAL / PART TIME - (3 Days per week or more)

3. REGISTRATION / ENROLMENT:

3.1 A registration I enrolment fee in the amount of R600.00 (six hundred Rand) shall be payable to the school on the same day as registration / enrolment. The said registration / enrolment fee Is not refundable under any circumstances whatsoever

3.2 Where more than one child is enrobed, an additional R300.00 (three hundred Rand) shall be added to

the registration / enrolment fee for each additional child.

3.3 The registration / enrolment fee may be paid as EFT transfer and/or direct deposit and proof of payment to

be handed in with your registration / enrolment form or emailed to [email protected] with your child’s name and surname listed as a reference.

3.4 Acceptance / rejection of me registration / enrolment will be communicated to the parents via email.3.5 Once the registration / enrolment form has been signed and a place allocated to the child, the contract

and medical forms must be completed and the first month fees paid for upfront, within one (1) month of acceptance, or Quirky Kids will give the parents adequate notice that it intends to terminate the

registration / enrolment application.3.6 Banking details:

Account Name: Quirky Kids (PTY)LTD

Bank: First National Bank

Type: Business Account

Account Number: 62841453351

Branch code: 254 905 (Cresta)

Reference: Name & Surname of child being enrolled.

Send proof of payment to: [email protected] or [email protected]

3.7 Parent(s) / Guardian to complete:

DATE REGISTRATION / ENROLMENT SUBMITTED: DATE OF COMMENCEMENT:

3.8 For OFFICE USE only

Receipt no for registration / enrolment fee paid:

Dale registration / enrolment fee was paid:





mailto:[email protected]



8. COMPULSORY DOCUMENTATION REQUIRED TO ACCOMPANY YOUR CHILD’S REGISTRATION

(preferably certified copies):

(An affidavit is required if two (2) single parents are living apart and/or together, stating which

parent is responsible for fees. All documents are required from both parents.)

8.1 Recent photograph of the child (do not send via email - BY HAND only)

8.2 Any assessments made by doctors, psychologists, etc. (if applicable)

8.3 Copy of the child’s birth certificate and/or passport if a foreigner

8.4 Copies of both parents (mother and fattier) / guardian’s identity document (or passport if a foreigner)

8.5 Permits for foreigners such as study permits, work permits etc.

8.6 Proof of residential address not older than 2 months.

8.8.1 If parents are divorced and/or separated, proof of residential address of both parents is to be submitted

8.8.2 Proof of residential address must be in the form of a lease agreement, Telkom account. Bank statement, etc.

8.7 Copy of maintenance agreement (if applicable)

8.8 Proof of both parents / guardian’s current employment / student status (e.g. letter from employer / university / college on company / university / college letterhead confirming employment / student status. This must include either party’s period of employment / student status, position held and proof of income and/or confirmation of study course and duration thereof)

8.8.1 If either parent / guardian is unemployed, and affidavit is required to this effect.

8.8.2 If either parent / guardian is self-employed or owns their own business, an affidavit is required stating the business name, address and business registration number

8.9 Copy of marriage certificate / death certificate / divorce decree (if applicable)

8.10 Full beta-s of the person responsible for the payment of the child’s aftercare fees (if not the biological parents) (such as proof of residential address, work details and contact details, together with a certified copy of Identity document is required)

9. COMPULSORY DOCUMENTATION TO BE COMPLETED WHEN HANDING IN YOUR REGISTRATION FORM (along with registration / enrolment fees and/or foreigners deposit (if applicable

before acceptance of child)

9.1 Quirky kids aftercare contract form (to be completed within one (1) week of registration / enrolment)

9.2 Quirky kids aftercare medical form (to be completed In full - including milestones)

9.3 All documents are required from (the guardian if the child is not living with his/her biological parents





10. DISCLOSURE OF PERSONAL INFORMATION:10.1 I/We understand that the personal information given in this registration / enrolment form is to

be used by Quirky kids for the purposes of assessing credit worthiness

10.2 I/We confirm that the information given in this registration / enrolment form is accurate and complete.

10.3 I/We further agree to update the information supplied as and when necessary in order to ensure the

accuracy of the above information Quirky Kids will not be liable for inaccuracies.

10.4 Quirky kids has my/our consent at all limes to contact and request information from any persons,

credit bureau or business. Including those mentioned in the credit application form

10.5 I We give permission to obtain any Information relevant to my/our credit assessment,

10.6 I/We expressly acknowledge that Quirky kids may:

10.6.1 perform a credit search on my/our record with any registered credit bureau when assessing my/our application:

10.6.2 monitor my/our payment behaviour by researching my/our record with any registered credit bureau;

10.6.3 use new information and data obtained from ono or more of the registered credit bureaus in

respect of future applications.

10.6.4 record the existence of my/our account with Quirky kids with any registered credit bureau

10.6.5 recant and transmit to one (1) or more of the registered credit bureaus, the details of how l/we

have performed and how my/our account is conducted.

11. PARENTS / GUARDIAN REMARKS:

Please provide any information that Quirky kids should be aware of that is not mentioned on this

registration / enrolment form (example: allergies, special needs, etc.)?

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12. MARKETING FEEDBACK:

Where did you hear about Quirky kids

□ Word of mouth (please specify name) _

□ Internet search (e.g. Google, please specify) _

□ Other {please specify)

□ Quirky Kids website

NOTE; No child will be accepted at Quirky Kids unless the Indemnity form attached (below) ties been fully completed and signed by the Parent(s) / Guardian If the application is rejected for whatever reason, management decision in this regard is final.

NOTE: Once the registration / enrolment form and all other relevant documents (see page 5) are handed in only then will the contract form be handed over to the Parent(s) We give seven (7) days for the contract form to be completed and handed into the office Failure to do sowill result in a penalty fine of R200.00 and possible suspension of your child.

The Parents) / Legal Guardian(s) of (Full

name and surname of the child)

I/We hereby certify that ail the information supplied on the registration / enrolment form is complete and accurate

I/We hereby confirm that l/v/e have read and understood the terms and conditions of the

document and accept and agree to be bound by them.

I/We further confirm that I/We agree with the price and method of payment as stipulated in this registration

/ enrolment form and declare that l/we fully understand the requirements in this regard.

Thus done and signed at (place) on the day of (month) 20 (year)

_____________________________ _____________________________ _______________________________Mother / Guardian signature Father / Guardian signature Karen Daniels

Owner Quirky Kids Aftercare

_____________________________ _____________________________Witness 1 signature Witness 2 signature





INDEMNITY FORMFULL NAME OF CHILD DATE OF BIRTH DATE OF APPLICATION

FULL NAME(S) OF PARENT(S) / LEGAL

GUARDIAN/S (if applicable):

MOTHER: _______________________________________________________________

FATHER: _____________________________________________________________________

GUARDIAN: ______________________________________________________________

1. This is a legal document and forms the basis of n contract between Quirky Kids and the said parent / guardian.

2. The parent(s) / guardian shall be responsible (or nil damages caused by their children to any property of the Quirky Kids Centre fair wear and tear excluded.

3. The parties recognise and acknowledge the Impetuous and impulsive nature of children

3.1 In view of this all persons in charge of the child at Quirky Kids have been instructed to take every precaution to the best of his-Tier ability to ensure the child's safety.

3.2 However, neither they nor any persons connected to Quirky Kids will accept any liability for any claims arising from any accident or injury to the child due to criminal acts or acts of negligence by outsiders or incidents that fall outside the responsibilities and duties of the acting person with due diligence and care and in the course and scope of their duties.

4. Whilst it is understood that Quirky Kids shall take reasonable care, Quirky Kids shall in no way be held liable for any damages suffered, by way of theft, injury, excursions, and travel or sport activities or otherwise, by the child, the parent or any other person (this includes personal possessions and burglaries), or in the case of injury or damages arising from:

4.1 any extra mural activity or other activities whatsoever in which the child participates whilst attending.

4.2 any defect in the condition of the food served on the premises Quirky Kids anything or any object belonging to or

situated on Quirky Kids premises;

4.3 from the fetching and taking of the child to or from outing destinations in a vehicle belonging to or being used by Quirky Kids

4.4 on collecting and/or taking the child to or from his/her school’s premises in a vehicle belonging to or being used by transport helpers for Quirky Kids.

5. Quirky Kids will not be held liable for children who contract contagious diseases either at home and/or at Quirky Kids.

6. For not notifying Quirky Kids about children’s allergies in writing and completing Quirky Kids medical form correctly.

7. Furthermore, the parent(s) / guardian agrees to waive and abandon any claims which may, at any time, arise as aforesaid, both in the parent(s) / guardian's personal capacity and In the parents’ capacity as a parent or as guardian of the child.

8. The parent(s) / guardian expressly indemnifies the supervisor or such authorized person against any claim which may arise or be instituted unless criminal negligence Is proven against such supervisor or authorised person in a court of law.





9. The parent(s) / guardian agrees that in an emergency requiring medical attention or hospitalization, the supervisor of the group, or, in his/her absence, any other responsible person connected with it, may give (he required permission and sign the necessary consent for the child to be subjected to surgery or other medical treatment, provided that this will be executed on the advice, and under the supervision, of a medical doctor.

10. Furthermore, the parent(s) / guardian accepts full responsibility for and agrees to bear al medical costs and expenses in relation to the parent(s) / guardian's child under these circumstances

11. No parent(s) / guardian is allowed to make any demands or to request a replacement of any object or item whatsoever from any other child, parent(s) / guardian or staff member

12. its members, agents, servants, employees and owners / officers accept no liability whatsoever, and without prejudice to the generality of the aforesaid, for any damages (whether consequential or otherwise).

13. The signatory/ies to this agreement, by his/her signature confirms that he/she accepts that Quirky Kids and the persons aforesaid accept no liability ty as aforesaid and indemnifies and holds Quirky Kids and the persons aforesaid absolved from any such liabilities

14. This registration / enrolment form, shall constitute the entire registration agreement between the parties and no representation by any of the patties or their agents, whether made prior or subsequent to the signing of this agreement shall be binding on any of the parties unless in writing and signed by the parties.

15. I/We hereby certify’ that all the information supplied on the registration / enrolment form is complete and accurate

16. 16 I/We hereby confirm that l/We have read and understood the terms and conditions of the document and accept and agree to be bound by them

17. 17. I/We further confirm that L/we agree with the price and method of payment as stipulated in this registration / enrolment form.

I/We the Mother/ Father / Guardian of the child (name/surname of child)

hereby agree to accept and abide by the terms and conditions governing with which

l/we declare myself/ourselves fully acquainted.


_____________________ _________________________ _____________________________

Mother /Guardian signature Father / Guardian signature Karen Daniels, OwnerQuirky Kids Aftercare.






For OFFICE USE only:

REGISTRATION / ENROLMENT APPROVED REGISTRATION / ENROLMENT NOT APPROVED

Date: Signature: Date: Signature:

NOTES:

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FEE STRUCTURE

AFTERCARE FEES (13H00 TO 18H00 / MONDAY TO FRIDAY)

DETAILS AFTERCARE(INCLUDED SCHOOL HOLIDAYS)

AFTERCARE(SCHOOL TERM ONLY)

MONTHLY FEES R 2860-00 R1870-00

ADDITIONAL MONTHLY FEESChildren with wheelchairs R 150 00 R 150-00

ENROLMENT FEE(once-off. non-refundable) R 600-00 R 600-00

••DEPOSIT(foreigners only)

R 2,000-00Day Rate R100 /Day R 1,600-00

Included FREE

Homework SupervisionLunch / Snacks

Breakfast (during school holidays)Fun Activities (during school holidays)

Homework SupervisionLunch / Snacks

NOTES:

*Monthly Fees are subject to change at owner's discretion (subject to terms & conditions).

** If one (1) or both parents are foreigners, a once-off refundable deposit is required equivalent to one (1) month's fees (subject to terms & conditions).





MEDICAL INFORMATION

FORM AFTERCARE

1.PERSONAL DETAILS OF CHILD:(Please use block letters)

SURNAME: TITLE: GENDER

FIRST NAMES: DATE OF BIRTHIDENTITY NUMBER:Certificate)

NUMBER OF CHILDREN in Household / Family:

NAME OF MEDICAL AD (if applicable): MEDICAL AID NO: DEPENDENT NO:

SCHEME: PRINCIPAL MEMBER:

RELIGION (for blood transfusions): ALLERGIES:

MEDICAL ASSESSMENTS (handed in)CHRONIC ILLNESS/ES:

CLINIC NAME (if applicable):

FAMILY DOCTOR NAME:

PRACTICE NUMBER:

TEL NO:

PHYSICAL ADDRESS OF DOCTOR:

______________________________________________________

______________________________________________________

______________________________________________________

IN CASE OF EMERGENCY:(Please provide contact name and numbers of next of kin / family / friend)

NAME:

RELATIONSHIP:

TEL NO:

CELL NO:

IN CASE OF EMERGENCY:(Please provide contact name and numbers of next of kin / family / friend)

NAME:

RELATIONSHIP:

TEL NO:

CELL NO:





2. IMPORTANT MEDICAL INFORMATION:Has the child had any serious accidents? YES / NO Please explain if YES

Has the child had any operations / medical procedures? YES / NO If YES, please provide details

Any other medical information that might be needed in a medical

CURRENT MEDICATION NAME/S (if applicable & dosage):

PERMANENT MEDICATION NAME/S (if applicable):

PRE-EXISTING CONDITION'S (example diabetes, etc. that medication is required for, if applicable):

3. STATE WHETHER YOUR CHILD HAS CONTRACTED THE FOLLOWING DISEASES LISTED BELOW AND WHEN (DATE):(If your child has NOT had any of the diseases listed below, please state NO.)





DISEASES YES or NO DATE OF OCCURENCES

Whooping Cough

German Measles / Rubella

Smallpox

Chickenpox

Polio

Scarlet fever

Diphtheria

Mumps

TB

AIDS /HIV (please state if she /he is on antiretroviral)

Meningitis

Hepatitis A, B or C

Pre-existing condition (e.g. diabetes) are important for paramedics and doctors to know about. It is important to update this part of the form and to inform Quirky Kids about updates.

4. IF YOUR CHILD IS ALLERGIC TO ANY FORM OF MEDICATION (e.g. PENICILLIN), INJECTIONS, TABLETS, POLLEN, GRASS, FOODS, etc.), PLEASE STATE BELOW HOW IT MANIFESTS ITSELF.

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5. IN CASE OF EMERGENCIES, IF YOUR CHILD HAS AN INJURY THAT REQUIRES MEDICAL TREATMENT SUCH AS STITCHES, BROKEN BONES, FRACTURES, etc., MAY HE / SHE BE TAKEN FOR TREATMENT TO A HOSPITAL OR TO A DOCTOR? PLEASE STATE YES OR NO. IF NO, STATE REASON THEREOF.[The Parents / Guardian WILL be notified prior to us going ahead with treatment.)

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6. CHILD HEALTH INFORMATION:

HAS THE CHILD YES or NO OUTCOME COMMENTS

Been tested tor ADD / ADHD?(Copy of test outcomes to be attached, if applicable)

Wears conserve shoes? Reason:

Does the child have any speech problems or undergoing speech therapy? State how often aid reason:

Undergoing physiotherapy, occupational therapy (OT), or other treatments? State therapy and treatment

Been diagnosed or suspected of having any of the following Disorders: Autism, ADHD. ADD, Bipolar, Asperger's Disease, Edwards Disease, etc. ?Please state which one below:

Diagnosis:

Copies of assessments {ram doctors, psychologists, etc. must accompany this form.Please note that at correspondence is held as highly confidential.

• Please remember to send a detailed report with all assessments that your child has received from the relevant doctors, psychologists, therapists, etc.

• We require a doctor's proof of medication to be administered daily, if applicable.

7. MEDICAL MATTERS:

7.1 The staff at Quirky Kids undergo training and do a refresher course every two years in FIRST AID ICPR.

7.2 Children who are ill MAY NOT be brought to aftercare especially under the following conditions:

7.2.1 Within 12 hours of a high temperature

7.2.2 Within 48 hours of going onto an antibiotic

7.2.3 Spots and rashes

7.2.4 Ringworm and impetigo

7.2.5 Infected eyes

7.2.6 ANY runny tummy

7.2.7 Vomiting

7.2.8 Yellow, green or brown runny noses

7.2.9 Weeping ears

7.2.10 a clinic or doctor certificate is required stating that your child's free from lice and nits before he/she may rerun to aftercare.

7.3 When a child has been on an antibiotic tor 48 hours and deemed well enough to return to aftercare (and not contagious to others), the aftercare teacher will administer the remainder of the antibiotic at appropriate times.





7.4 If a child is to receive medicine during the course of the day, the Parent(s) / Guardian(s) must tot Quirky Kids knew via email

7.5 Medication must be written up in our Medicine Register during the school holiday periods.

7.6 Medicines may not be left in the child's bag but handed to the aftercare teacher.

7.7 It is the Parent(s) / Guardian (s) responsibility to remember to collect the medication from the aftercare teacher / antibiotics kept in the fridge.

7.8 Without the Medication Register having been PROPERLY filled out and signed, no medication wilt be administered to that

child, instruction will not be taken ever die telephone or from the Quirky Kids message / communications book.

7.9 If a child appears or gets sick at Quirky Kids we will contact the Parents) I Guardian(s) and the Parent(s) / Gaudian(s) must

make immediate arrangements to collect their child.

7.10 If the Parentis). Guardian(s) can not take lime-off from work, they must organise with a friend, grandparent, etc. or a responsible person to rafted their child in the event of sickness.

7.11 BEE STING ALLERGIES: If your child is allergic to bee stings, the Parent(s) Guardians(s) must leave a bottle of Antihistamine at Quirky Kids When this expires, the parent/guardian replaces it.

7.12 A doctor's certificate is to accompany the child on return lo Quirky Kids, stating illness and condition and day of safety to return to Quirky Kids in the event of any sickness.

7.13 SICK CHILDREN BELONG AT HOME AND NEED TENDER LOVING CARE.

8. IMPORTANT INFORMATION TO BE COMPLETED IN FULL:

Does your child have any pets and/or pet allergies?

Left-handed, right-handed or ambidextrous?

Good, average or poor eater?

Does the child have any problem which we should be aware of (medical and/or behaviour, etc.) ?

How would you describe your child’s personality?

Are there any special family circumstances which may be a factor in your child’s present behaviour, such as divorce, death, new baby, recent move, hospitalization? Please explain:





What concerns do you have about your child's present behaviour?

What are you doing about these concerns?

Responsibility to school homework?

Reading difficulties?

Please add any comments that you feel will help us know your child better


_____________________________ _____________________________ _______________________________Mother / Guardian signature Father / Guardian signature Karen Daniels

Owner Quirky Kids Aftercare






MENU 1

Oats /banana muffins/loaf Juice/milo/hot chocolate

Ham/cheese rolls Juice/milo/hot chocolate

Toasted chicken-mayo Juice/milo/hot

chocolate

Watermelon slices Juice/milo/hot

chocolate

Fruit salad & ice cream Juice/milo/hot chocolate

Pancakes cinnamon & sugar Juice/milo/hot chocolate

Gold Tabloons & chips Juice/milo/hot chocolate

FRIDAYS ARE M I L K S H A K E DAYS ///





MENU 2

Flapjacks and juice/milo

Chicken strips and chips Juice/milo/hot chocolate

French Toast fingers Juice/Milo/hot

chocolate

Mac & cheese parcels Juice/Milo/hot

chocolate

Muffins Juice/Milo/hot chocolate

Fish fingers & chips Garlic bread bites

Juice/milo/hot chocolate

Hot dogs

Juice/milo/hot chocolate

Savory - mince pancakes Juice/milo/hot chocolate





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