Wishart Outside School Hours Care Enrolment Form

Wishart Outside School Hours Care (WOSHC)

Enrolment Form - Existing Families only. New families to the Service will be required to create an account first via the link under enrolments: www.wishartsspnc.org/woshc
Fields marked with a red asterisk are MANDATORY.

Please note: a seperate enrolment form is required for each child
Primary Parent/Guardian

The person who will claim the Child Care Subsidy
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Relation to Child*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone*
Alternate/Work Phone
Email Address*
example@example.com
Your Country of Birth*
Your Cultural background*
CollectionEmergencyTransportationMedicalExcursion
YesNo
If "Yes', please provide your CRN Number
If 'No', I acknowledge that I am currently not providing a CRN. If in the registration process I can provide the CRN when enrolling or alternatively I advise I have no CRN to provide in this enrolment form, and as a result will not have CCS and other Government payments made to my account to reduce my out of pocket expenses.
YesNo
If 'Yes', please advise of your current status
If you are currently working, please advise of your current employer
Secondary Parent/Guardian
Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Relation to Child
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone
Alternate/Work Phone
Email Address
example@example.com
Your Country of Birth
Your Cultural background
CollectionEmergencyTransportationMedicalExcursion
YesNo
If 'Yes', please advise of your current status
If you are currently working, please advise of your current employer
Additional Contact 1

Form includes fields for two (2) additional contacts. If you require more than 2 contacts please email the additional contacts details to the Service on woshc@wishartsspnc.org
Name*

First NameLast Name
Relation to Child*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone*
Alternate/Work Phone
CollectionEmergencyTransportationMedicalExcursion
Additional Contact 2

Form includes fields for two (2) additional contacts. If you require more than 2 contacts please email the additional contacts details to the Service on woshc@wishartsspnc.org
Name*

First NameLast Name
Relation to Child*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile*
Please enter a valid phone number.
Alternate/Work Phone
Please enter a valid phone number.
CollectionEmergencyTransportationMedicalExcursion
Medical Contact

Please enter your child's Doctor information.
Name/Practice Name
Relation to Child
Practice Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EmergencyMedical
Child's Information
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Gender*
Child's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child primarily lives with*
Child's Country of Birth*
Primary language*
Are any other languages other than English spoken at home? Please note all secondary languages
Cultural Background*
YesNo
If "Yes', please provide details
YesNo
If 'Yes', please provide their CRN Number
Child's year level (and class if known)*
If your child is transitioning from Kindy to Prep, please attach their Kindy Transition form here.

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Child's Medical Conditions and Health Care needs
YesNo
If "Yes', please provide details
YesNo
If "Yes', please provide details
YesNo
If "Yes', please provide details
YesNo
If "Yes', please provide details
YesNo
If "Yes', please provide details
YesNo
If "Yes', please provide details
Please attach any Medical Management Plans, Anaplylaxis Medical Management Plans or Risk Minimisation Plans with respect to the child's healthcare needs, medical conditions or allergies. Action Plans should be updated yearly and from a medical practitioner, together with a current photo.

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Child's Dietary Requirements and Restrictions
YesNo
If "Yes', please provide details
YesNo
If "Yes', please provide details
Please attach any Medical Management Plans, Anaplylaxis Medical Management Plans or Risk Minimisation Plans with respect to the child's dietary needs or dietary allergies. Action Plans should be updated yearly and from a medical practitioner, together with a current photo.

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Medical - General
Child's Medicare Number
YesNo
In the event of illness, injury, accident or emergency involving my child, I authorise staff at Wishart OSHC to take whatever action or medical attention is necessary, with the use of all health and other personal information which the Association has relating to the child, for the purpose of enabling staff to: administer care and assistance to the child - including any medical hospital and ambulance service in the case of an accident or emergency involving my child in accordance with the Policy and Procedures of the Service; and report any injury or illness as required by law.*

YesNo
YesNo
YesNo
YesNo
Immunisations

You will be required to either upload a copy of your child's Medicare Immunisation Statement or Exemption Form. We must have a copy of either of these documents to complete enrolment.
YesNo
If "Yes', please upload a copy of the exemption form which you used for ACIR.

Cancelof
Please upload a recent copy of the child's Medicare Immunisation Statement. You can login to Medicare to download a copy via www.humanservices.gov.au/customer/dhs/medicare*

Cancelof
Court/Parenting Orders or Parenting Plans
YesNo
If "Yes', please provide details
YesNo
If "Yes', please provide details
Please upload any Court/Parenting Orders, or Parenting Plans, that are currently in force.

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General Terms and Conditions
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
For the safety and protection of children, and in keeping with our Duty of Care considerations, the Association has strict procedures regarding the arrival and departure of children and particularly the persons who may collect children from this Service. Persons must be at least 16 years old to sign a child in or out at this Centre. To sign in or out attendance on the Centre tablet, the person must use their own mobile phone number and unique pin and be authorised to sign in/out the child.*

YesNo
I understand that my child is bound by the Centre rules, policies and procedures during the period of my child's enrolment. I understand that my child will be under the care and the guidance of the staff of the service and agree to support their positive approaches to guiding children's behaviour. I understand that should my child's behaviour be unable to be supported by staff, that I will be contacted and asked to collect my child.*

YesNo
YesNo
YesNo
YesNo
Fees and Charges
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
This enrolment form is in accordance with the Education and Care Services National Regulations.
Child Care Subsidy (CCS) Enrolment Agreement

As a part of your enrolment at our service we require you to confirm acceptance of the following items in order to be eligible to receive Government funding if available. Acceptance of these items as well as some of the other information in the enrolment form can be used as a Complying Written Arrangement.
YesNo
YesNo
YesNo
YesNo
Additional Information
Please provide any further information you feel the Service should know about the child.
Signed acknowledgement of WOSHC Enrolment
Signature
Date

DayMonthYear
Date
Thank You

We will contact you should we require any further information.
Should be Empty:

Wishart Outside School Hours Care (WOSHC)

Primary Parent/Guardian

Secondary Parent/Guardian

Additional Contact 1

Additional Contact 2

Medical Contact

Child's Information

Child's Medical Conditions and Health Care needs

Child's Dietary Requirements and Restrictions

Medical - General

Immunisations

Court/Parenting Orders or Parenting Plans

General Terms and Conditions

Fees and Charges

Child Care Subsidy (CCS) Enrolment Agreement

Additional Information

Signed acknowledgement of WOSHC Enrolment

Thank You