THE FUNHOUSE - ENROL Byron Bay

THE FUNHOUSE
ENROL - BYRON BAY at ST FINBARR'S
CASUAL CARE-Available Now!

Please leave a message to book or enrol at The Funhouse in Byron Bay

EMAIL ADDRESS

stfinbarrsoshc@gmail.com

PHYSICAL ADDRESS

St Findbarr's Primary School
165 Bangalow Road, Byron Bay

St Finbarr’s OSHC Enrolment Form

Child’s Name:

ATTACHED DOCUMENTS
Please ensure ALL of the following documents are attached to this application before submission:
Child’s birth certificate

Child Customer Reference Number (CRN)

AIR Immunisation record

Medical documents & Action Plans (ASCIA)

Parent Customer Reference Number (CRN) and date of birth

Legal documents, regarding custody arrangements, court order, parental agreements, parenting plans, parenting order etc.

Documents regarding additional needs or diagnosed disability

Service name:

Address:

Phone number:
Email:

OFFICE USE ONLY

Date Entered:
Entered By:

CHILD DETAILS
Education and Care Services National Regulations - Regulation 160 (3a, e)

Family Name

First given name

Middle name

Preferred first name

Date of Birth

Gender
(Please circle)
Male / Female

Centrelink Reference Number (CRN)
Please note: Parent and child have their own individual CRN number

Child’s home address

Child normally lives with

Primary School attending

Child’s Year Level & Teacher

Days of attendance (Please circle):
Mon
Tue
Wed
Thurs.
Fri

Morning Session Required (Tick):

Afternoon Session Required (Tick):

Child’s Start Date

CULTURAL CONSIDERATION
Education and Care Services National Regulations - Regulation 160 (f, g, h)

Is your child of Aboriginal or Torres Strait Islander origin?

       No         Aboriginal         Torres Strait Islander         Both

Does your child speak a language other than English at home?

(Please circle) Yes / No
If yes, what language (s) other than English are spoken at home.

County of birth

Child’s residency status

What is your child’s cultural background?

Please outline any cultural practices
you would like followed

Religion

Please outline your child’s religious background and if relevant any religious practices/celebrations you would like followed.

PRIMARY PARENT
Education and Care Services National Regulations - Regulation 160 (3b)

Parent Name
[Primary Parent must also be the registered CRN number holder]

Parent Surname

Address

Phone Number/s
(H)

(M)

(W)

Parent Date of Birth:

Email address

Relationship to child

Country of Birth

Parent Centrelink Reference Number (CRN):
[See Primary Parent]

Please provide any relevant cultural background details

Does the child normally live with you? (Please circle)
Yes / No

Occupation

SECONDARY PARENT
Education and Care Services National Regulations - Regulation 160 (3b)

Parent Name

Parent Surname

Address

Phone Number/s
(H)

(M)

(W)

Parent Date of Birth

Email address

Relationship to child

Country of Birth

Parent Centrelink Reference Number (CRN)

Please provide any relevant cultural background details

Does the child live with you? (Please circle)
Yes / No

Occupation

FAMILY LAW, AVOs OR OTHER RELEVANT COURT ORDER
Education and Care Services National Regulations - Regulation 160 (3c, d)

Are there any relevant court orders, parenting orders or parenting plans relating to the powers, duties and responsibilities or authorities of any person in relation to the child or access to the child?

Yes/No

If yes, please provide all relevant
documentation and paperwork

Attached

Are there any other relevant court orders relating to the child’s residence or the child’s contact with a parent or other person?

Yes/No

If yes, please provide all relevant
documentation and paperwork
Attached

Have photographs and names of unauthorised people been attached to this form?

Yes/No
Attached

Briefly outline court order requirements

Please note that without this documentation we cannot legally enforce the Order/s.

CHILD CARE SUBSIDY (CCS)

Child Care Subsidy will be paid directly to the Service to reduce the fees families pay. To claim Child Care Subsidy (CCS) families must meet eligibility requirements which include:
1. You and/or your partner must care for your child at least 2 nights per fortnight or have 14% care?
YES ☐ NO ☐
2. Are you liable for fees for care provided at an approved childcare service?
YES ☐ NO ☐
3. Do you meet residency requirements?
YES ☐ NO ☐
4. Does your child meet immunisation requirements?
YES ☐ NO ☐
5. Have you completed the Child Care Subsidy assessment on the MyGov website?
YES ☐ NO ☐
6. Have you received confirmation about your Child Care Subsidy?
YES ☐ NO ☐

Please Note:
If you need assistance with filling out this form, please speak to the Nominated Supervisor who will be happy to help. Please ensure that if any details change, you notify the Service immediately.

MEDICAL INFORMATION
Education and Care Services National Regulations - Regulation 160 (3a, I, j)
To ensure your child’s safety, it is essential that you inform our Service of any medical conditions, including known allergies before enrolment. If any information changes to an existing condition or you become aware of a newly diagnosed condition, you should contact management as soon as possible.

Child’s Medicare Number

Medicare Expiry Date

Child’s Medicare reference number

Doctor’s name

Medical Centre

Phone number

Doctor’s address

Dentist name

Name of Service

Phone number

Dentist’s address

Private Health Cover
Yes / No
Private Health Fund Name

Private Health Care Membership Number

Ambulance Cover
Yes / No

Do you authorise the Nominated Supervisor or another educator at the Service to seek medical treatment from a registered medical practitioner, hospital or ambulance service?

Yes/No
Parent 1
Signature:

Parent 2
Signature:

Do you authorise the Nominated Supervisor or other educator at the Service to seek dental treatment from a registered dental practitioner or service in the event of an emergency?

Yes/No
Parent 1
Signature:

Parent 2
Signature:

Do you authorise the Nominated Supervisor or other educator to transport the child in an ambulance in the event of an emergency?
Yes/No
Parent 1
Signature:

Parent 2
Signature:

CHILD’S MEDICAL DETAILS AND HEALTH CONDITIONS

Allergies- provide details of child’s allergies.
These can include insect stings, food (eg nuts, eggs, peanuts) animals, latex, medication or other

Allergy to

Medical specialist or doctor who may be currently treating your child for this condition

Phone contact

Address

Risk of Anaphylaxis
Yes/No
Has a doctor diagnosed this allergy?
Yes/No

Does your child have a current Action Management Plan?
Yes/No
Has your child been prescribed an adrenaline autoinjector?
Yes/No

If your child has been prescribed an adrenaline autoinjector, you will need to provide this to the Service (and renew prior to expiry date).

Please be advised that if your child is diagnosed with asthma or anaphylaxis and an emergency occurs, the Nominated Supervisor or other educators may administer emergency first aid without making contact. Educators will notify the child’s parents and/or emergency services as soon as possible.
Education and Care Services National Regulations - Regulation 94.

Yes/No

Parent 1
Signature:

Parent 2
Signature:

Does your child have any special dietary requirements or restrictions? Yes/No
Prohibited Food
Detailed information

MEDICAL CONDITIONS OTHER THAN ALLERGIES, AND ANAPHYLAXIS (ASTHMA, SEVERE ASTHMA, EPILEPSY, DIABETES other)
Medical condition

Has a doctor diagnosed this condition?
Yes/No

Does your child have a current Medical Management Plan (eg ASCIA Asthma Plan)
Yes/No

If yes, is this plan attached?
Yes/No

Have plans been sighted by educator/Nominated Supervisor
Yes/No

REQUEST FOR MY CHILD TO SELF ADMINISTER PRESCRIBED MEDICATION

Do you agree to your child independently self-administer their own medication?
Education and Care Services National Regulations - Regulation 96.
Yes/No
Parent 1
Signature:

Parent 2
Signature:

Please indicate the medication that your child has permission to self-administer (eg: asthma reliever, enzymes for cystic fibrosis).

Doctor’s name

Medical Centre

Phone Number

Signature

Date

Students in infant classes may require supervision when self-administering medication and other aspects of healthcare management. In accordance with their age and stage of development and capabilities, older students can take responsibility for their own health care. Self-management must follow an agreement by the student and parents/guardians, the Service and the student’s medical/health practitioner.

Please advise if your child’s medical condition creates any difficulties with self-management, for example, difficulty to remember to take medication at specified times or difficulties coordinating equipment. Please include information about how you support your child at home to administer their medication.

Medication agreement

Medication will only be administered if:
it is prescribed by a medical practitioner it is in the original container with the original label the label contains the child’s name instructions and dosage can be clearly read expiry date or use by date is valid any verbal or written instructions provided by the medical practitioner must be provided by the parent/s
Education and Care Services National Regulations Regulation, 95

Any medication, including non-prescription medication like creams and paracetamol, must be authorised by parents or an authorised nominee on our Administration of Authorised Medication form.

Education and Care Services National Regulations Regulation 93
Parent 1
Signature:

Parent 2
Signature:

IMMUNISATION DETAILS
Education and Care Services National Regulations - Regulation 160 (3a, I, j)

AIR Immunisation History Statement or AIR Immunisation History Form is provided and has words ‘up to date’ recorded.

Yes/ No

Attached

AIR Immunisation History Statement Medical Exemption Form is provided recording medical contraindication/natural immunity.
Yes/ No

Attached

Air Immunisation History Form is completed by a GP/nurse when the AIR does not have a record of immunisations and a ‘catch up’ schedule has been initiated.

Yes/ No
Attached

FAMILY INFORMATION

Does your child have any siblings attending our Service? If so, please provide their names and ages.

Does your child have other siblings at home or attending school? If so, please provide their names and ages.

Does your child have any other close relations attending the Service? If so, please provide their names and ages.

DEVELOPMENTAL INFORMATION

Please provide any relevant information

Does your child have any problems with hearing, sight or speech?

Does your child have a physical disability or delay, including intellectual, sensory or physical impairment?

Does your child require additional support for learning because of disability?

Is there anything that you do or modify at home that may assist us to meet the educational needs of your child?

Is this the first time your child has been in care? If yes, please indicate the type of early education and care your child has experienced.

FIRST EMERGENCY CONTACT -AUTHORISED NOMINEE
Education and Care Services National Regulations - Regulation 160 (3b, ii, iii, iv, v) 161 (1a, I, ii, 1b)

There may be times or situations where your child has had an accident, injury, trauma or illness and
parent/s cannot be reached or are unable to collect their child. Please nominate two people who are authorised to be contacted in case of an emergency and/or are authorised to collect your child. Each person must live a maximum of 30 minutes from the Service and must provide identification when collecting the child.

Please ensure you have obtained the person’s consent before listing them as an emergency contact.

Full Name

Relationship to child

Phone Number
(H)

(M)

(W)

Email Address

Can this person be contacted to collect your child from the education and care service
Yes/No
Parent 1
Signature

Parent 2 Signature

Can this person be contacted to give consent for medical treatment or to authorise for a Nominated Supervisor or educator to administer medication to the child in the event that you cannot be contacted? (Please Circle)
Yes/No
Parent 1
Signature

Parent 2
Signature

Can this person be contacted to give consent for educators to take the child outside the Service’s premises in the event that you cannot be contacted?
(Please Circle)
Yes/No
Parent 1
Signature

Parent 2
Signature

Can this person give authorisation for the Service to take the child on regular outings?
(Please Circle)
Yes/No
Parent 1
Signature

Parent 2
Signature

SECOND EMERGENCY CONTACT- AUTHORISED NOMINEE
Education and Care Services National Regulations - Regulation 160 (3b, ii, iii, iv, v) 161 (1a, I, ii, 1b)

Full Name

Relationship to child

Phone Number
(H)

(M)

(W)

Email Address

Can this person be contacted to collect your child from the education and care service or family day care educator
Yes/No
Parent 1
Signature

Parent 2
Signature

Can this person be contacted to give consent for medical treatment or to authorise for a Nominated Supervisor or educator to administer medication to the child in the event that you cannot be contacted? (Please Circle)
Yes/No
Parent 1
Signature

Parent 2
Signature

Can this person be contacted to give consent for educators to take the child outside the Service’s premises in the event that you cannot be contacted?
(Please Circle)
Yes/No
Parent 1
Signature

Parent 2
Signature

Can this person give authorisation for the Service to take the child on regular outings?
(Please Circle)
Yes/No
Parent 1
Signature

Parent 2
Signature

ENROLMENT AGREEMENT
Please read the following agreement carefully before signing. If there is anything within this document that you are unsure of, please ask for clarification.
HEALTH AND SAFETY
I/we give permission for this child to: Participate in outings to places of interest

(A permission slip will have to be signed before allowing your child to leave the Service)
YES
NO

I/we give permission for this child to apply SPF30+ sunscreen prior to sun exposure (If not, please provide a letter releasing the Service of any Liability)
YES
NO

Have Band-Aids or sticking plasters applied when necessary
YES
NO

Have staff apply Insect Repellent (supplied by parents)
YES
NO

PHOTOGRAPHY AND VIDEO
For photos and video footage to be taken of my/our child for Service use and staff training purposes (footage will not leave the Service)
YES
NO

For photos and video footage of my/our child to be used in Learning Stories, and to be shared with other families that attend the Service
YES
NO

For photos and video footage of my/our child to be used for student training purposes (Photos and video footage may leave the Service for students to present to lecturer and class for viewing and marking)
YES
NO

For photos and video footage of my/our child to be used on Service website, social media and other internet purposes, such as advertisement and used in organisation’s resources
YES
NO

FEE RESPONSIBILITY
ENROLMENT CARRIES AN OBLIGATION TO PAY ALL REQUIRED FEES

In signing below, you are confirming that you take full responsibility for payment of fees and charges as required under Outside School Hours Care Fees Policy.

I understand my child’s continued enrolment is dependent on my fees being paid in line with the Outside School Hours Care Fee Policy. I agree to pay a once only Enrolment Fee of $25.00 per family I am aware there is a late fee of $10.00 for every 5 minutes or part thereof if I collect my child after 6.00pm.
Signature:                                                                 Print Name:                                                   Date:

PARENT AGREEMENT
Education and Care Services National Regulations - Regulation 160 (3a, I, j)
Please tick box to confirm you have read each point:
  I agree to inform the Service in writing immediately of any changes to the above information.   I agree to pay the Service enrolment fee and bond prior to my child starting and am aware that the enrolment fee is non-refundable. Bond is refundable under conditions outlined in the Policy Manual.   I agree to keep my fees paid up to date and understand that my child’s position at the Service will be in jeopardy if my fees are not kept up to date. I understand that all booked days are paid for even when my child is absent due to sickness or on holidays.   If I am unable to collect my child by closing time, I will organise for one of the people listed as authorised contacts to collect my child prior to closing time. I am aware that if my child has not been collected by closing time, and I am unable to be contacted, those persons nominated as authorised contacts will be called by Service staff to collect my child.   I agree to pay a late fee of $10.00 every 5 minutes or part thereof after closing time. In the event that a child is left at the Service for over an hour after closing and Service staff have been unable to contact anyone to collect the child, educators or the nominated supervisor may be required to take your child to the local Police Station to await your arrival. A note will be left detailing your child’s whereabouts. In this instance, the Service is also obligated to notify relevant Child Protection Agencies and/or the Regulatory Authority.   I agree to provide two weeks written notice to withdraw my child or reduce booked days.   I authorise a qualified staff member to administer a single dose of paracetamol (Panadol) appropriate to my child’s age, in the event of my child experiencing a high temperature and other measures of reducing the temperature have not worked. In this event, I agree to collect my child as soon as possible, or organise for someone else to collect my child.

  I give permission for prescribed medication to be administered by Service primary contact staff upon my authorisation on the Service’s Administration of Medication form. I understand that if details are filled in incorrectly or left blank or if the medication does not meet the standards of the Service’s policy the medication will not be given unless, in the case of missing or incorrect details I can be contacted to authorise the missing details. I agree to inform the staff both verbally and in writing of the need for medication for my child. I understand that non-prescription medication will not be given by staff unless it is accompanied by a current letter (within 6 months) from a General Practitioner stating the name of and reasons for the medication, and only then, if the Nominated Supervisor deems the child well enough to attend Service.   I give permission for my child to be observed by educators of the Service and students supervised by the educators. I give permission for my child to participate in programs organised by practicum students under the supervision of an educator. I am aware that confidentiality is always respected and that students will not be left with children without an educator present. I give permission for my child to be involved with leisure activities offered at the OSHC Service.   I have read the Parent Handbook and am familiar with the Service’s Policy Manual located on the premises. I agree to follow, support and abide by these policies and am aware that staff members are available to discuss any policies that I do not fully understand. I know that if I have any suggestions this can be given verbally to a staff member or anonymously in the suggestion box.   I, or someone I know, has a skill they could share with the children to enhance the educational program. I have read and understood the information in this application. Information provided about my child/ren or other people, has been given with their authorisation.
Print Name: _ Signature:                                              Date: / /
Print Name: _ Signature:                                              Date: / /
Privacy Disclaimer
We acknowledge and respect the privacy of its clients. The enrolment information that is collected assists us to meet our legislative obligations and to provide the best level of education and care for your child. By completing this form, you have consented to this information being collected. The information will be used by educators/staff members and relevant government authorities. You have the right to access and alter personal information concerning yourself or your child in accordance with the Privacy Act 1988 and our Privacy and Confidentiality Policy.