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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
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 2
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
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 3
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
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 4
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
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 5
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
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 6
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: ______________________________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 7
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.
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 8
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: ________________________________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 9
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: _____________________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 10
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:__________________________________________________
Parent Signature: ________________________ Date: ___________________
Print Parent Name: _____________________
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:__________________________________________________
Parent Signature: ________________________ Date: ___________________
Print Parent Name: _____________________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 11
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.
Parent Signature: ________________________ Date: ___________________
Print Parent Name: _____________________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 12
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: _________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 13
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_______________________________________________________________
Parent Signature: ________________________ Date: ___________________
Print Parent Name: _____________________
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.
Parent Signature: ________________________ Date: ___________________
Print Parent Name: _____________________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 14
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
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 15
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: ____________________
Enrolment form Zig & Zag LDC
Reviewed 27th April 2016 16
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