The Kuluin School P&C Association OSHC Application for Enrolment (CWA)

The Kuluin School P&C Association OSHC Application for Enrolment (CWA)

PLEASE COMPLETE A SEPERATE ENROLMENT FORM FOR EACH CHILD
Please find our information pack by clicking on the link provided: https://form.jotform.com/231100301781034 If you have any issues completing this form please call the service on 07 5477 0175
1. Child Details
Child's Full Name:*

First NameLast Name
Preferred Name:
DOB:*
Home Address:*
Gender:*

MaleFemaleNon-Binary
School Class (At Time of Enrolment):*
PLEASE UPDATE THIS AT THE BEGINNING OF EACH SCHOOL YEAR
Child's Centrelink Reference Number (CRN):*
2. Parent/Guardian Details

Parent/Guardian 2
Name:*

First NameLast Name
DOB:*
Home Address:
(If different to Child)
Phone:*

HomeWorkMobile
Email:*
(All Invoices and Email Communications will go here)
Gender:*

MaleFemaleNon-Binary
Relationship to Child:*
Parent/Guardian 1's Centrelink Reference Number (CRN):*
WorkingStudyingOther
Employer/College/Other:
The date of births and Centrelink reference numbers (CRN) for the account holder and each child are required for the purposes of linking for Child Care Subsidy (CCS). To obtain CCS, Families MUST be assessed through Centrelink. Contact 13 61 50 for further information or log in through your Centrelink or MYGOV account. Full fees will apply for families not assessed or deemed ineligible.
Parent/Guardian 2
Name:

First NameLast Name
DOB:
Home Address:
(If different to Child)
Phone:

HomeWorkMobile
Gender:

MaleFemaleNon-Binary
Relationship to Child:
WorkingStudyingOther
Employer/College/Other:
3. Shared Care/Court Orders/Parenting Agreements
Are there any Shared Care Arrangements, Court Orders, Parenting Orders or Parenting Plans relating to your Child:*

YesNo
Relevant documentation may include Parenting Plans, Parental Responsibility Plans, Residence orders and Contact Order. A statement/letter signed by both parents will be acceptable in the instance of an arrangement of shared custody by mutual agreement.
Please upload a copy of this documentation*

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4. Emergency Contact/Collection Details
Please list the details of all additional adults, other than parents/guardians nominated in Section 2, who are authorised to collect your child and can be contacted in case of emergency. Please also indicate any other permissions you authorise each person to give. (Identification will be required upon their first visit to the service and on subsequent visits should staff require confirmation of identity.)
Full Name*

First NameLast Name
Phone:*

HomeWorkMobile
Relationship to Child:*
I confirm that this person is over the age of 18 (I.D will be required upon their first visit to the service)
I authorise this person to:*

Give permission for my child to attend excursionsConsent to medical Treatment/Permit medication to be given to my childNone of the above
Add another Adult:*

YesNo
Full Name*

First NameLast Name
Phone:*

HomeWorkMobile
Relationship to Child:*
I confirm that this person is over the age of 18 (I.D will be required upon their first visit to the service)
I authorise this person to:*

Give permission for my child to attend excursionsConsent to medical Treatment/Permit medication to be given to my childNone of the above
Add another Adult:*

YesNo
Full Name*

First NameLast Name
Phone:*

HomeWorkMobile
Relationship to Child:*
I confirm that this person is over the age of 18 (I.D will be required upon their first visit to the service)
I authorise this person to:*

Give permission for my child to attend excursionsConsent to medical Treatment/Permit medication to be given to my child
Add another Adult:*

YesNo
Full Name*

First NameLast Name
Phone:*

HomeWorkMobile
Relationship to Child:*
I confirm that this person is over the age of 18 (I.D will be required upon their first visit to the service)
I authorise this person to:*

Give permission for my child to attend excursionsConsent to medical Treatment/Permit medication to be given to my child
5. Health/Medical Details
Does your child experience asthma?:*

YesNo
If yes, indicate severity:*

MildSevere
List Triggers:*
Please upload your child's asthma management plan, you will be required to complete a separate medication authority form:*

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Does your child have any allergies?:*

YesNo
List Allergens:*
Indicate severity:*

MildSevereAnaphylaxis
Please provide details of symptoms/reactions:*
Please provide treatment details:*
Please upload an allergy management plan relating to your child. An Epipen will need to be provided if your child is at risk of Anaphylaxis:*

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Does your child have any specific dietary requirements?:*

YesNo
If yes, please provide details below including any reactions/symptoms if applicable:*
Does your child have any other medical conditions?:*

YesNo
If yes, please provide details below:*
Please provide details of any medical condition management plans relating to your child's medical conditions:

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Does your child require regular medication?:*

YesNo
If yes, please provide details below:*
If medication is required, a separate medication authority form is to be completed by the parent/guardian. All medication is to be provided in the original labeled packaging with the child’s name, doctor’s/pharmacist’s name, dosage and instructions.
What is your child's immunisation status?:*

Fully ImmunisedNot ImmunisedPartially Immunised
If you have selected Partially Immunised, please provide details of your child’s immunisation status below or send a copy of their immunisation record to oshckuluin@bigpond.com:*
6. Medical Practitioner Details
Doctor's Name:
Surgery/Practice Name:*
Address:
Phone Number:
Family Medicare No:*
7. Additional Information
Does your child have any religious/cultural beliefs that you would like us to be aware of?:*

YesNo
Please provide details:*
Does your child have any dislikes, fears or phobias?:*

YesNo
Please provide details:*
Is either parent/guardian or your child of Aboriginal or Torres Strait Islander descent?:*

NoYes - Parent/Guardian 1Yes - Parent/Guardian 2Yes - ChildRather not say
Is either parent/guardian or your child from a non-English speaking background?:*

NoYes - Parent/Guardian 1Yes - Parent/Guardian 2Yes - Child
Nationality/s and Language/s Spoken:*
English language level (Basic, Conversational, Fluent):*
Does either parent/guardian or your child have a disability?:*

NoYes - Parent/Guardian 1Yes - Parent/Guardian 2Yes - Child
Details:*
8. Behaviour Information
Does your child currently have a Positive Behaviour Support Plan through school?:*

YesNo
Please provide a copy of any Positive Behaviour Support plans relating to your child*

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Are there any particular behaviours that staff should be aware of?:*

YesNo
What are they?:*
Are there any identifiable triggers to the behaviour?:*

YesNo
What are those triggers?:*
9. Booking Information
Requested Start Date (please ensure booking confirmation is received before sending your child):*
Before School Care (BSC): please indicate requirements
Permanent BSC Days:*

MondayTuesdayWednesdayThursdayFridayI do not require permanent Before School Care Days. I will put my casual booking request in writing when required. I understand there is no guarantee of availability.
After School Care (ASC): please indicate requirements
Permanent ASC Days: (this automatically includes Vacation Care unless "Vacation Care is NOT required" is selected below)*

MondayTuesdayWednesdayThursdayFridayI do not require permanent After School Care Days. I will put my casual booking request in writing when required. I understand there is no guarantee of availability.
Vacation Care (VC): please indicate requirements
I require Vacation Care for the same days as my requested permanent ASC bookings, please automatically roll these into each school holiday period. I understand that I can cancel selected Vacation Care periods and incur no charges, by putting my cancellation in writing by the end of week 8 of each school term. I understand that Cancellations received after this time will be charged Vacation Care fees.I have not requested permanent ASC bookings and I will therefore submit my Vacation Care booking request in writing prior to each school holiday period. I understand there is no guarantee of availability and that I must await confirmation.Vacation Care is NOT required, please cancel my bookings for all school holiday periods. I understand that should I require Vacation Care at any stage I must put my request in writing and await confirmation.
Please ensure you have selected the correct option above. Days permanently booked for After School Care (ASC) are also automatically booked for Vacation Care unless you indicate that it is NOT required. This does NOT apply to Before School Care (BSC) bookings. Please refer to the Family Information pack for further details or contact the OSHC administration for clarification (oshckuluin@bigpond.com or 54770175).
10. Permission & Agreement Details

Please read and select each item to signal your agreement
1*

I give my consent to the information contained in this document and further information recorded by the service, being available to the Staff and Support Workers employed and engaged by Kuluin OSHC and Kuluin School to work with my child. I understand this information will be handled strictly in accordance with Privacy and Confidentiality Guidelines and will only be shared as a way of improving the quality of care provided to my child.
2*

I agree to notify the Service, in writing, of any change in the details outlined in this enrolment form.
3*

I understand that to access CCS funding, I must apply through Centrelink and that I will be charged full fees until the Program has received notification of CCS eligibilty through the CCS System. I understand that it is my responsibility to liase with Centrelink to ensure the correct information surrounding my entitlements is given to the service.
4*

I agree to inform Kuluin OSHC of any absence of my child as soon as possible and to pay any fee that may be incurred, as set out in the service policy.
5*

I agree to pay all fees published, updated and notified (including incidentals) for the days that my child has a permanent ongoing booking or a confirmed casual booking within the service. I acknowledge that fees will apply for all of these days regardless of attendance. I also acknowledge that fees are due by 6pm Friday of the week in which care is provided and that overdue account fees will be charged to my account if I fail to make payment by this time as per the Fees Policy.
6*

I understand that I am required to give 2 (two) weeks’ notice in writing, to permanently cancel all or part of my child’s permanent booking. I acknowledge that 1 (one) weeks’ notice applies to confirmed casual bookings. I understand that I am responsible for the fees accrued during the notice period and am aware that under Centrelink Policy, CCS may not be paid or may be retracted from the service at a later date for non-attendance. In this instance an invoice will be generated for full fees for which I will be responsible.
7*

I understand that the nature of the activities will include, but is not limited to, centre-based activities, community outings and mealtimes. I acknowledge that risk may arise during these activities. I understand that I will receive a separate permission form for any excursions.
8*

I authorise OSHC staff to provide any required first aid and to facilitate medical attention in the event of an emergency including the administering of life saving medication including but not limited to Epipen or Ventolin. I give permission for OSHC staff to engage or seek advice from any medical, hospital or ambulance service in the case of an accident or emergency involving my child and to liaise with other health/medical professionals in relation to the care of my child. I accept responsibility for payment of all expenses associated with such treatment. I understand that every effort will be made to contact me, or those authorised by me, in the event of any illness or accident.
9*

I understand that a Medication Form must be completed if I require my child to have medication administered during their time at OSHC. I have read the Medication Policy and agree to abide by the requirements when providing medication for administration.
Link to Medication Policy:

https://form.jotform.com/242821434785057
10*

I agree to keep my child from attending the program should he/she be experiencing any illness, contagious disease or fever.
11

I give permission for OSHC staff to assist my child to apply a SPF 30+ sunscreen prior to outdoor activities.
12*

I understand that my child requires a broad brimmed hat for outside play.
13

I give permission for OSHC staff to assist my child to apply insect repellant for outdoor activities.
14

I give permission for staff to take photos/videos of my child to record important events and special activities as part of the program. I understand that these photos will be displayed within the service and the school for the families to see and will also be used for the purposes of programming and evaluation.
15

I give permission for photographs/videos of my child to be posted to the Kuluin OSHC social media pages and the Kuluin OSHC App. I understand it is my responsibility to ensure I am informed of the terms and conditions of social media platforms in relation to photos/videos.
16

I give permission for my child to engage with media of various types, including but not limited to, games, movies, music with the Australian rating of ‘G’ or ‘PG’ for educational and entertainment purposes.
17

I give permission for my child to enjoy the sensory experience of going barefoot during their time at OSHC. I am aware that it is a requirement that my child has suitable shoes with them, and that staff will not permit my child to take off their shoes if they deem the environment unsafe to do so.
18*

I understand that should my child’s behaviour be unable to be supported by staff, that I will be contacted and requested to collect my child immediately.
19*

I understand that should my child intentionally leave the boundaries of the program, all attempts will be made by the service to ensure the safety of my child, however staff may be unable to follow them due to regulatory ratio requirements and I will be contacted to locate and collect my child. I understand that the police will be called if I am uncontactable or unable to attend immediately to ensure the safety of my child.
20*

I agree to receiving notifications/correspondence relating to OSHC, including invoices/statements via the email address listed.
21*

I have read and agreed to adhere to Kuluin OSHC's Policies and Procedures, as briefly outlined in the Family information Package. I am aware that I can request a copy of the full Policy & Procedure Manual or a specific Policy to be emailed to me. I will discuss these with my child and make them aware of their obligations.
22*

I agree to be polite and respectful in all of my dealings with Kuluin OSHC and it's staff. I will raise any concerns I have in an appropriate manner either in person or via phone or email. I understand that I am not to approach any child or other person regarding any grievances I may have but direct them to the Kuluin OSHC Leadership Team. I am aware that I can approach the Kuluin School P&C Executive via email if my grievances have not been resolved. I accept that I may be banned from the service and the Police may be called if I behave inappropriately.
23*

I am aware that if I have any questions, I can contact the service to talk with an OSHC Admin Team Member to discuss my child’s enrolment and attendance at the Program.
24*

I have completed the Application for Enrolment Form honestly and to the best of my knowledge. I understand that I must contact the Program immediately if any information changes.
11. Family info Pack
You can access our Family Information Pack through this link:

https://form.jotform.com/231100301781034
I have read and understand the information provided to me in the Family Info Pack
An Enrolment Processing Fee must be paid before the Enrolment will be processed*

I will come into the service to pay by EFTPOSPlease email me the account details to pay by Bank Transfer
Meet and Greet*

I understand that it is a requirement of the service that they meet myself and my child prior to positions being offerred and I will therefore call into the service at my earliest convenience. (Please be prepared to wait if visiting between 2:50pm and 3:15pm as this is our busiest time of day)
Parent/Guardian 1 - Account Holder
Parent/Guardian 1's Name:*

First NameLast Name
Preferred Email:*
example@example.com
Date

DayMonthYear
Please email a copy of my request (I understand that this is not a confirmation of my Booking):*

YesNo
Signature*

Clear
Should be Empty:

The Kuluin School P&C Association OSHC Application for Enrolment (CWA)

1. Child Details

2. Parent/Guardian Details

3. Shared Care/Court Orders/Parenting Agreements

4. Emergency Contact/Collection Details

5. Health/Medical Details

6. Medical Practitioner Details

7. Additional Information

8. Behaviour Information

9. Booking Information

10. Permission & Agreement Details

11. Family info Pack