Enrolment form 2022

FIRST PARENT: *

First Name Last Name
D.O.B: *

Month Day Year
(for Child Care Benefit)
CRN: *
Address: *

Street Address

Suburb

Postcode State
Home Phone
Mobile Phone: *
Please enter a valid phone number.
Email Address: *
example@example.com
Occupation: *
Work Place:
Work Phone:
SECOND PARENT:

First Name Last Name
D.O.B:

Month Day Year
(for Child Care Benefit)
Address:

Street Address

Suburb

Postcode State
Home Phone
Mobile Phone:
Email Address:
Occupation:
Work Place:
Work Phone:

Cultural information on family (N/A if not applicable) *

	Child	Parent/s
Ethnic / Cultural Identity:
Language spoken at home:
Religion:

Family Circumstances:
Is there anything the Centre should be aware of?

Name & ages of siblings:

	Name	Age
Sibling 1:
Sibling 2:
Sibling 3:
Sibling 4:

Does your child attend any other Centre: *

Yes No
If Yes which Centre?
What days of attendance?

Monday Tuesday Wednesday Thursday Friday
Does your child have a sibling who attends another approved long day care, family day care or outside school hours care service?

Yes No
How many allowable absences has your child used this financial year?

Emergency Contact Persons (other than parent):
Person 1: *

First Name Last Name
Relationship to child: *
Suburb *

Street Address

Street Address Line 2

Suburb
Home phone:
Please enter a valid phone number.
Mobile phone: *
Work phone:
Person 2: *

First Name Last Name
Relationship to child: *
Suburb *

Street Address

Street Address Line 2

Suburb
Home phone:
Please enter a valid phone number.
Mobile phone: *
Work phone:

Persons authorised to collect this child (other than parent):
Person 1: *

First Name Last Name
Relationship to child: *
Suburb *

Street Address

Street Address Line 2
Phone: *
Person 2:

First Name Last Name
Relationship to child:
Suburb

Street Address

Street Address Line 2

Suburb
Phone:

Persons NOT authorised to collect this child:
Person 1:

First Name Last Name
Relationship to child:
Suburb

Street Address

Street Address Line 2
Phone:
Person 2:

First Name Last Name
Relationship to child:
Suburb

Street Address

Street Address Line 2
Phone:
Are there any Court orders or parenting plans affecting this child? *

Yes No
If Yes, please explain

Health
Childs Doctor: *

First Name Last Name
Address:

Street Address

Suburb

Postcode State
Phone: *
Childs Medicare No: *
Health Fund that has issue a policy by which the child is covered:
Is your child fully immunised? *

Yes No
Does your child have additional needs or special requirements? (Please give details) *
Does your child have any allergies? (Please give details including symptoms & treatment and any medical management plan, anaphylaxis medical management plan or risk minimisation plan to be followed with respect to a specific healthcare need, medical condition or allergy) *
In the case your child has a tick, do you give permission for the educators to apply Lyclear cream that contains permethrin to the tick? (as recommended by the North Coast Health Department) *

Yes No
Does your child have any fears of animals? (If Yes, which one/s) *
Does your child have food restrictions? (Religious / Ethical / Health reasons) *
Has your child ever been hospitalised? (Please give details) *
Is your child currently on any ongoing medications? (Please give details) *
Have you noticed any development (language, physical, intellectual, social) difficulties that your child may benefit from support in? (Please give details) *
Does your child have any special interests/needs or emotional requirements? *
Any other information that may assist with the successful inclusion of your child at the Centre? (Fears / Family situations / Religious beliefs)

Child's Information
We ask for this information to help us personally ensure your child's needs are met and they develop a strong sense of belonging at the centre.
Past history in child care / separation from parent; *
Favourite activities (can help in settling); *
Toileting; *
Sleep Routine; *
Food (Good eater/fussy); *
Personality/temperament; *
Any concerns in regards to areas of development; *
Family information/Cultural background; *
Other relevant information;
If your child has an allergy, asthma or anaphylaxis please complete the management plans available on request.

Fee Payment Agreement Form
Childs Name: *

First Name Last Name
Parent 1 Name: *

First Name Last Name
Parent 2 Name:

First Name Last Name

I / We agree to abide by the Federal Community Children's Centre Fee Payments and Arrears Procedure, which sets out the procedure for fee payment by direct debit (available in the Policy folder in the Parent library in entrance area).

I / We agree to pay and Enrolment fee of $50 (accident insurance costs, administration, and a school hat) and an annual family Membership fee of $20.

I / We agree to pay the fees two weeks in advance. These will be deducted via direct debit fortnightly or weekly on a day of your choice.

I / We agree to ensure that there are sufficient funds in the account on the Direct Debit day to ensure that payment is honoured.

Preschool Children only:

I/we agree to pay the additional fees if our child attends longer than 8am-3.30pm. The extra hours will need to be prebooked every term. The fees will be $5 per 1/2 hour.

In the case that the extra time has not been prebooked the late fee will be $1 per minute for pick up after 3.30pm. Once the pick up exceeds 4.30pm the fee will increase to $3 per minute.

Long Day Care Children:

I/we agree to pay a late fee of $1 per minute for late pick-ups after 4.30pm up to 4.35pm - from 4.35pm this fee increases to $3 per minute.

I / We agree to pay fees for days my child is booked in regardless of absences or holidays.

I We understand fees will be charged for public holidays.

I / We understand that parents of children enrolled in Long Day Care are required to pay for all school holidays, except for the 4 week closure of the service of December / January.

I / We agree to pay an annual maintenance fee of $100. The fee will be deducted in lots of $50 at the start of the year and in June. The fee is refundable after completion of 2 Volunteer days by parents.

I / We agree paying fees is my responsibility as I have enrolled my child. The service is not responsible for chasing overdue fees from parents.

I / We agree that two weeks notice in writing must be given for cancellation of enrolment. I am aware that fees will be charged until written notice has been given to the Centre.

I / We understand that Fees will be invoiced and distributed to all families on a weekly or fortnightly basis for the fees for the upcoming fortnight. Fee payments are due within 14 days.

I / We acknowledge that if fees are not available in our account we will be responsible for any bank charges and / or Debit Success charges.

I / We acknowledge taht if fees are not available by the due date, the arrears policy will be followed, placing my chid's future attendance at the Centre in jeopardy.

I / We agree that if our financial circumstances change and I / we are unable to pay as agreed, we will immediately notify the Director or Administrator to request alternative payment arrangements.

The contact person for the payment of fees at the Centre is the Administrator.

Signature 1 *

Clear
Signature 2

Clear
Date *

Month Day Year
Date
Compulsory Volunteer Days
Please tick two or more events you will be able to volunteer at or let us know how else you will be able to volunteer eg. share your skills with the children or at the centre *

Cultural Diversity Night Working bee - April Federal Film Night - date to be confirmed Family Fun Day - September End of year Concert Bush tucker garden working bee Join our Committee and meet with us every 6 weeks between 3.30pm and 4.30 pm on a Wednesday (free training available) Contribute $100 Annual Maintenance Fee instead of Volunteering Other

Vaccination Record

LEGAL REQUIREMENTS
A child cannot come to our centre without us first having this document:

To enrol in an early childhood education and care service, parents/guardians must provide a copy of one or more of the following documents:
1. A current ACIR Immunisation History Statement which shows that the child is up to date with their scheduled immunisations.
2. A current ACIR Immunisation History Form on which the immunisation provider has certified that the child is on a recognised catch-up schedule.
3. An ACIR Immunisation Exemption - Conscientious Objection Form which has been certified by an Immunisation provider and a parent/guardian. (An ACIR Conscientious Objection letter certifying that a Conscientious Objection Form has been lodged previously with the ACIR is also acceptable).
4. Conscientious Objection Forms are only valid if your child was enrolled before 2018.
Other records such as the NSW Personal Health Record (Blue Book), a GP letter or an overseas immunisation record will not be accepted.

Parents/guardians may obtain a copy of their child's Vaccination History Statement at any time:
- By telephone on 1800 653 809
- By email on acir@medicareaustralia.gov.au
- Online at www.medicareaustralia.gov.au/online
- In person at the local Medicare office, Centrelink office or Child Support Service Centre.
Medical Contraindication - specific vaccine(s)

Children who have a medical contraindication for a scecific vaccine(s) will require an ACIR Immunisation History Statement that shows the child is up to date with all of their other vaccinations along with a Medical Contraindication Form, signed by a doctor/immunisation nurse, showing which vaccine(s) the child is unable to receive.

Medical Containdication - all vaccine(s)

Children who cannot receive any vaccinations due to a medical condition(s) require a Medical Contraindication Form signed by a doctor/immunisation nurse.
*

I agree to these terms and conditions

Application for Membership of Association

Federal Community Children's Centre Incorporated (incorporated under the Associations Incorporation Act 1984)
I, First Name* Last Name* of , Street Address* City* State* Postcode* and Occupation* , hereby apply to become a member of the above named incorporated association. In the event of my admission as a member, I agree to be bound by the Rules of Association for the time being in force.
Signature of applicant *

Clear
Date *

Month Day Year
Date
Please fill in above this line only
I, (Full name) a member of the association, nominate the applicant who is personally known to me, for membership of the association.
Signature of member
Date:
I, (Full name) a member of the association, second the nomination of the applicant who is personally known to me, for membership of the association.
Signature of member
Date:
Federal Community Children's Centre

898 Binna Burra Road, Federal NSW 2480

Ph. 02 66884371

Email: info@federalccc.com.au

ABN:4144 6709 631

Enrolment Checklist
To finalise the enrolment we will need:

Completed and signed enrolment form Direct Debit Agreement Copy of your child's birth certificate Copy of your child's current immunisation status - It is illegal for your child to start at the Centre without a copy of this. The report is created from: https://www.humanservices.gov.au/individuals/services/medicare/australian-immunisation-register Completed and signed Membership application $50 Non-refundable Enrolment fee paid to account details below
Once all these documents are in place and enrolment fee has been paid, we can proceed with your enrolment.

Please check above which you have provided/included so far.
Account Details for deposit

Federal Community Children's Centre Inc

Bsb 032 573

Account 295105

Please use your child's name as your reference, or send us an email confirming the payment. This will go towards your child's enrolment fee when your child is given a place.
Please verify that you are human *
Should be Empty:

ENROLMENT FORM 2022

Administrator/Director Signature:

Permission form

Fee Payment Agreement Form

Vaccination Record

Application for Membership of Association

Enrolment Checklist