Preschool Enrolment Form
This form will record your name, please fill your name.
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Child's First Name
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Child's Middle Name
Child's Last Name
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Child's Date of Birth
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Month
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Day
Year
Date
Child's Address (the address your child spends the majority of their time at)
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Gender?
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Male
Female
Non-binary
Please list some of your child's interests?
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Does your child have any special dietary needs? (please list: vegetarian, vegan, kosher, diabetic etc)
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Does your child have any allergies or intolerances? (including allergy to sunscreen)
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Is your child at risk of anaphylaxis? (If yes, you are required to provide a medical management plan)
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Yes
No
If applicable, please attach your child's Medical Management Plan (this plan must be provided by a medical practitioner)
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Does your child speak English?
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Yes
No
Does your child speak any other languages?
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What culture or religion is your child?
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Please supply your child's Medicare Number
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Does your child have private health insurance? (If yes, please provide the insurer name, type of cover and policy number)
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Please supply your child's Medical Practitioners details. (Practice, doctor name, address and phone number)
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Is your child using any regular medications? (If yes, please provide details)
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Is your child asthmatic?
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Yes
No
If applicable, please upload a Medical Management Plan issued by a Medical Practitioner for the management of your child's asthma condition.
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Does your child have any additional needs? (If yes, please provide details)
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Do you have any concerns about your child's development? (speech, hearing, physical, cognitive, behaviour - please provide details)
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Child's Immunisation (please provide a record of your child's immunisation history)
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Expected Start Date
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Month
/
Day
Year
Date
Attendance Days
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Monday
Tuesday
Wednesday
Thursday
Friday
Parent/Carer 1 - First name
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Parent/Carer 1 - Middle name
Parent/Carer 1 - Last name
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Parent/Carer 1 - Date of Birth
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/
Month
/
Day
Year
Date
Do you hold a concession card
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Yes
No
Please provide a copy of your concession card
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Parent/Carer 1 - Gender
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Male
Female
Non-binary
Parent/Carer 1 Occupation
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Parent/Carer 1 - Please provide information of the language/s you speak and your cultural background, and/or religion
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Parent/Carer 1 - Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Carer 1 - Phone number
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Parent/Carer 1 - Work phone number
Parent/Carer 1 - Email address
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example@example.com
Parent / Carer 1 - Martial status
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Single
Married
In a relationship
Separated or divorced
What is Parent/Carer 1 - Relationship to the child?
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Are there any court orders or custody agreements in place? (If yes, it is a requirement that you provide documentation to the preschool)
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Yes
No
Please upload any court orders or custody agreements
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Parent/Carer 1 - License or Identification
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Parent/Carer 2 - First name
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Parent/Carer 2 - Middle name
Parent/Carer 2 - Last name
*
Parent/Carer 2 - Date of Birth
*
/
Month
/
Day
Year
Date
Do you hold a concession card
*
Yes
No
Please provide a copy of your concession card
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Parent/Carer 2 - Gender
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Male
Female
Non-binary
Parent/Carer 2 - Occupation
*
Parent/ Carer 2 - Please provide information of the language/s you speak and your cultural background, and/or religion
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Parent/Carer 2 - Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Carer 2 - Phone number
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Parent/Carer 2 - Work phone number
Parent/Carer 2 - Email address
*
example@example.com
Parent/Carer 2 - Martial status
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Single
Married
In a relationship
Separated or divorced
What is Parent/Carer 2 - Relationship to the child?
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Parent/Carer 2 - License or identification
*
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Emergency Contact 1 (not the parent or carer) - Full name
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Emergency Contact 1 - Phone number
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What is Emergency Contact 1 - Relationship to the child?
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Do you consent to Emergency Contact 1, to collect your child from the preschool? (please note that the preschool needs a copy of this persons licence or identification
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Yes
No
Emergency Contact 1 - License or Identification
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Do you authorise Emergency Contact 1, to consent to medical treatment to be given to your child by a registered medical practitioner, hospital or ambulance service?
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Yes
No
Emergency Contact 2 (not the parent or carer)- Full name
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Emergency Contact 2 - Phone number
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What is Emergency Contact 2 - Relationship to the child?
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Do you consent to Emergency Contact 2, to collect your child from the preschool? (please note that the preschool needs a copy of this persons licence or identification
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Yes
No
Emergency Contact 2 - License or Identification
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Do you authorise Emergency Contact person 2, to consent to medical treatment to be given to your child by a registered medical practitioner, hospital or ambulance service?
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Yes
No
Child's CRN (customer reference number, this can be obtained through Centrelink)
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Parent/Carer 1 - CRN (customer reference number, this can be obtained through Centrelink)
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Parent/Carer 2 - CRN (customer reference number, this can be obtained through Centrelink)
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Please indicate any person who is authorised to give consent for an educator to take your child outside the preschool premises (please note that the preschool will always seek consent for any outings outside the preschool premises, this question allows the service to know who is authorised to provide the consent)
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Please indicate any person who is authorised to give consent for the service to transport or arrange transport for your child (please note that the preschool will always seek consent prior to any activity to requires transportation, this question allows the service to know who is authorised to provide the consent)
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Permission for your child to participate in spontaneous local walks and to use the garden areas at the preschool. Excursions are organised to further advance learning in curriculum subjects, giving your child opportunities for valuable real life experiences.
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I consent for my child to participate in walks along Mount Crosby Road
I consent for my child to use spaces at the front, left and right of the preschool building
I consent for my child to cross Mount Crosby Road and to visit the Reserve Cafe
Agreement:
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I agree to always pay my fees on time. (please note that parent 1 & 2 are both responsible for fees due)
I agree to give 14 days notice to terminate my child's enrolment and I understand that my deposit will only be refunded if 14 days notice is given
I agree to pay in full any costs incurred to access emergency services for my child
I agree to notify the preschool of any infectious conditions my child presents with
I agree to abide by all polices, procedures and regulations outlined in the parent information handbook
I authorise:
Young Einstein Discovery Preschool educators to administer Panadol or Nurofen in the case of sudden illness
Young Einstein Discovery Preschool educators to administer any first aid treatment necessary and in the best interests of my child
Young Einstein Discovery Preschool educators to call for emergency services in the case of any emergency involving my child
Young Einstein Discovery Preschool educators to take photographs of my child to be used as evidence of their learning and to be displayed within the preschool premises and on the Storypark App
Professional photographers to photograph my child for annual preschool photographs and for these photographs of my child (class photo) to be shared with other families enrolled at the preschool (please note that the preschool can not be liable for how these photos are shared or distributed)
Photographs of my child to be used in advertisements or on social media to promote the preschool
Young Einstein Discovery Preschool educators to apply sunscreen to my child (if your child has a sunscreen allergy, please supply a safe sunscreen for your child to use)
I understand that:
educators will only administer prescribed medication when it has been prescribed by a Medical Practitioner
in the case of a serious emergency, emergency services will be contacted first and then the parent/carer
In the case of an emergency my child may be taken off the preschool premises in the best interest of their safety
it is my responsibility to carefully read all policies and procedures outlined in the Parent Information Handbook
Acknowledge that you have made enrolment payments Account name: YEDP Pty Ltd for the trust BSB:064 178 Account number: 1078 3602 (Please use your child’s name as the description when making online payments).
I have paid the $200 security bond (fully refunded at the end of your child's enrolment when you give 14 days notice and all fees are paid to date)
I have paid the $20 administration fee (non refundable)
I have received the Parent Information Handbook and read all Policies and Procedures included in the handbook
Birth Certificate
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