2025 Enrolment Form

2025 Enrolment Form

All information contained in this enrolment form is regarded as confidential and shall only be viewed by primary contact staff. Please ask us if you need assistance with any part of this form. Please read each section carefully before completing and signing. Please complete a separate form for each child you are enrolling.
Please upload a recent photograph of your child*

Head and shoulders only; no hats. Please submit in JPEG, JPG, or PNG format.
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Please upload a recent photograph of Parent/Guardian #1*

Head and shoulders only; no hats. Please submit in JPEG, JPG, or PNG format.
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Please upload a recent photograph of Parent/Guardian #2*

Head and shoulders only; no hats. Please submit in JPEG, JPG, or PNG format.
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Child's Details
Child's full name*

First NameLast Name
Preferred name
Date of birth*

DayMonthYear
Date
Sex*

MaleFemale
CRN number
Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country of birth*
Primary language spoken at home*
Family/Religious/Cultural practices to be respected
Dietary restrictions (involving food and/or activities)

Parent/Guardian #1 Details (MANDATORY)
Name*

First NameLast Name
Preferred name
Relationship to child*
Email address*
Invoices and EHOOSH correspondence to be emailed to this address*

YesNo
Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile*
Please enter a valid phone number.
Phone number (home)
Please enter a valid phone number.
Occupation*
Employer*
Work address*
Date of birth*

DayMonthYear
Date
Country of birth*
Language(s) spoken at home*
Are you an Australian resident?*

YesNo

Parent/Guardian #2 Details
Name

First NameLast Name
Preferred name
Relationship to child
Email address
Invoices and EHOOSH correspondence to be emailed to this address

YesNo
Home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile
Please enter a valid phone number.
Phone number (home)
Please enter a valid phone number.
Occupation
Employer
Work address
Date of birth

DayMonthYear
Date
Country of birth
Language(s) spoken at home
Are you an Australian resident?

YesNo

Custody Information
Child resides with

Both parentsMotherFatherShared custodyOther (please specify)
Other (please specify)*
Are there any court orders, parenting orders or parenting plans in relation to your child (or access to your child)?

YesNo
If YES, please provide details*
Is a copy of the court order attached?

YesNo
Upload court order

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NOTE: The service cannot enforce custody issues without a copy of the relevant court order. Please discuss any custody issues with the Nominated Supervisor before enrolment.

Child Care Subsidy (CCS)
To claim CCS you must complete an assessment with the Family Assistance Office. Please call 13 61 50 or visit https://www.servicesaustralia.gov.au/child-care-subsidy.

Your combined annual family income and your activity test determines the amount of CCS you are entitled to. CCS will be paid directly to OOSH to reduce the fees you pay. To be linked correctly please provide us with:

• The parent’s Customer Reference Number (CRN) and their date of birth
• The child’s CRN and their date of birth
• Official spelling of name as shown on assessment letter from Family Assistance Office.
Have you been assessed by the Family Assistance Office?*

YesNo
Parent name (as shown on assessment letter)*

First NameLast Name
CRN number*
Fees are paid by direct debit only. A separate Direct Debit Agreement needs to be submitted to the service before we will accept enrolments.

Demographic Information and Priority of Access
This information is required for priority of access and the annual government census we are required to complete. Please tick all that apply.*

AboriginalTorres Strait IslanderTwo parent/guardian familyWorking parentsSingle parent/guardian familySingle parent working, studying, or trainingNon-English-Speaking BackgroundA child at serious risk of harm
Number of parents working*

Immunisation

The service requires a copy of your child’s immunisation record, which can be downloaded from your MyGov account. Please upload the document below.
Has your child received the necessary immunisations?*

YesNo
If NO, please provide details*
Upload immunisation record

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NOTE: Children with no immunisation record will be classified as unimmunised and may be excluded if there is an outbreak of a vaccine-preventable disease at the service.
Signature of Educator

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Date signed

DayMonthYear
Date

Child's Profile
Please provide details about your child's interests (e.g., hobbies, sport, books, games, art and craft, music, play, etc.)
NOTE: Educators talk to your child about their interests regularly and where possible these interests will be incorporated into our program.
Activities that you would like to see reflected in our program (e.g., cultural celebrations, learning of life skills, etc.)
Ways in which you would be interested in contributing to our program (e.g., sharing a recipe from home, helping in our garden, sharing your expertise with children and/or educators, participating in fundraising activities, etc.)
How does your child interact with others? (e.g., are they outgoing/reserved/shy?)
How well does your child communicate with others? Please provide details regarding interaction with other children/adults/older children.
How is conflict handled by your child?
How does your child self regulate their emotions? Do they need any additional support?
Does your child need any additional help with carrying out and completing tasks?
How does your child cope with routines and transitions?
Does your child require communication aids? (Such as visuals and/or sign language)

Disclaimer/Informed Consent
I hereby acknowledge that:
- I have read and understood the service’s Policies and Procedures contained in this enrolment record and policy manual, which forms part of this agreement (and which may be changed from time to time by the service at its sole discretion).
- The Policies and Procedures incorporate any relevant statutory obligations imposed on the service and have been put in place to protect my child/children.
- I must strictly always comply with the Policies and Procedures.
  The information provided in this enrolment record is to the best of my knowledge correct.
- I will inform the service immediately in writing if there are any changes to the information provided by me in this enrolment record (Notice of Change).
- When caring for my child/children the service will rely on the information provided by me in this enrolment record, in any Notice of Change and any other instructions/information (of any nature whatsoever) I give to the service.
- I am totally responsible for the accuracy of the information and my compliance with the Policies and Procedures.
- I am totally responsible for the suitability and actions of any person (third party) whom I authorise to visit, deliver, or collect my child/children to/from the service.
- I must first inform any such third party about the Policies and Procedures and that they must strictly comply with them.
- Subject to any applicable Australian Consumer Law, the Sales of Goods Act 1923 (NSW) or any other applicable law which cannot be excluded, I/we will indemnify the service, its employees or any of its authorised persons from any loss, damage, claim, cost or expense of any nature whatsoever incurred by my child/children, by me or by a third party in connection with any act or omission by us failing to comply with the Policies and Procedures and/or due to the inaccuracy of the information.
I have read the above information and acknowledge it*

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Date*

DayMonthYear
Date

Membership
The service is an Incorporated Association and, as such, by enrolling my child in the service I agree to be bound by the rules of the Association for the period of my child’s enrolment. I understand that as a member of the Incorporated Association, one representative of my child’s family is entitled to voting rights at any General Meeting held by the service and that I may be nominated (with consent) for a position on the Management Committee at the Annual General Meeting.
The person nominated for member representation is:
Insert parent/guardian's name
Booking Form

Please complete the Booking Form.
Declaration
I hereby declare that, to the best of my knowledge, the information provided in this enrolment form is true and accurate.
Parent or guardian's full name (please print)*

First NameLast Name
Signature*

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Date*

DayMonthYear
Date

Direct Debit Service Agreement

Please complete the fields below to authorise direct debit payments with HubHello. By filling out this section, you consent to HubHello debiting your account as per the terms outlined in the Direct Debit Request Service Agreement.
Parent/Guardian name*
“you” - Request and authorise HubHello to arrange, through its own financial institution, a debit to your nominated account for the total amount of the fees owed on your parent account. This debit or charge will be subject to the terms and conditions of the Direct Debit Request Service Agreement.
Financial institution name*
Payment method*

Bank accountCredit card
Name on account*

First NameLast Name
BSB number (must be 6 digits)*
Account number*
Name on card*
Credit card number*
Expiry date*
Card type*

VisaMastercard
By signing and/or providing us with a valid instruction with respect to your Direct Debit Request, you have understood and agreed to the terms and conditions governing the direct debit arrangements between you EHOOSH and HubHello, as set out in this Request and in your Direct Debit Request ServiceAgreement.*

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Date*

DayMonthYear
Date
Fees and Charges

Hubworks will charge a fee for the processing of direct debit:

Bank Account: 75c per transaction

Visa/Mastercard: 75c plus 0.9% of transaction total

AMEX:75c plus 3.85% of transaction total
Overview

This is your Direct Debit Service Agreement with HubHello Pty Ltd ACN 160 176 018.

It explains what your obligations are when undertaking a Direct Debit arrangement with us. It also details what our obligations are to you as your Direct Debit provider.

Please keep this agreement for future reference. It forms part of the terms and conditions of your Direct Debit Request (DDR) and should be read in conjunction with your DDR authorisation.

Definitions

• account means the account held at your financial institution from which we are authorised to arrange for funds to be debited.
• agreement means this Direct Debit Request Service Agreement between you and us.
• banking day means a day other than a Saturday or a Sunday or a public holiday listed throughout Australia.
• debit day means the day that payment by you to us is due.
• debit payment means a particular transaction where a debit is made.
• direct debit request means the Direct Debit Request between us and you.
• us or we means HubHello, (the Debit User) you have authorised by requesting a Direct Debit Request.
• you means the customer who has signed or authorised by other means the Direct Debit Request.
• your financial institution means the financial institution nominated by you on the DDR at which the account is maintained.

1. Debiting your account

1.1 By signing a Direct Debit Request or by providing us with a valid instruction, you have authorised us to arrange for funds to be debited from your account. You should refer to the Direct Debit Request and this agreement for the terms of the arrangement between us and you.

1.2 We will only arrange for funds to be debited from your account as authorised in the Direct Debit Request.

Or

We will only arrange for funds to be debited from your account if we have sent to the address nominated by you in the Direct Debit Request, a billing advice which specifies the amount payable by you to us and when it is due.
Should be Empty:

2025 Enrolment Form

Child's Details

Parent/Guardian #1 Details (MANDATORY)

Parent/Guardian #2 Details

Family Details

Custody Information

Child Care Subsidy (CCS)

Demographic Information and Priority of Access

Emergency and Authorisation to Collect Child From Service Contacts

Medical Information

Immunisation

Child's Profile

Authorisation and Approval (Permission)

Disclaimer/Informed Consent

Membership

Booking Form

Declaration

Direct Debit Service Agreement