HLG STEAMist Education Enrolment Form

Child Information

We respect and support all family structures and identities. Please provide the information you’re comfortable with.
Full Name:

First NameLast Name
Date of Birth:

DayMonthYear
Gender:
Preferred Name:
Does your child have a nickname or another name they prefer to be called? If not, please write "N/A" in this field.
Primary Parent/Guardian Information

We respect and support all family structures and identities. Please provide the information you’re comfortable with.
Full Name:

First NameLast Name
Relationship to Child:
Mobile Phone:
Please enter a valid phone number.Format: 0000000000.
Email:
example@example.com
Work Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Parent/Guardian (if applicable)

We respect and support all family structures and identities. Please provide the information you’re comfortable with.
Full Name:

First NameLast Name
Relationship to Child:
Mobile Phone:
Please enter a valid phone number.Format: 0000000000.
Email
example@example.com
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address for Care
Full Address:

Street Address

Street Address Line 2

CityState

Postcode
Additional Details:
(e.g., apartment/unit number, parking instructions, or other relevant location notes)
Emergency Contact 1
Full Name:

First NameLast Name
Relationship to Child:
Mobile Phone:
Please enter a valid phone number.Format: 0000000000.
Emergency Contact 2
Full Name:

First NameLast Name
Relationship to Child:
Mobile Phone:
Please enter a valid phone number.Format: 0000000000.
Feeding Information

Some of the following questions might not apply to older children (e.g., bottles, nap time). If that’s the case, please write "N/A".
Does your child require bottle feeding?
If yes, is the milk:

Other
What time(s) does your child usually have bottle feeds?
What are your child's usual meal times?
(e.g., times for breakfast, lunch, snacks, dinner)
Additional Feeding Notes - please include any preferences, instructions, or special considerations:
(e.g., allergies or dietary restrictions)
Nap and Sleep Information

Some of the following questions might not apply to older children (e.g., bottles, nap time). If that’s the case, please write 'N/A' in those fields.
What time does your child usually wake up?
Does your child take naps? Please tick all that apply.

Other
If your child takes naps, what time(s)?
Do they follow a wake window? If so, what is it?
What time does your child go to bed?
Does your child have any specific routines to help them relax or fall asleep?
(e.g., songs, books, patting, rocking, self-settling)
Activities and Comfort
What activities does your child enjoy?
(e.g., outdoor play, arts and crafts)
Does your child have any comfort item(s)? If yes, what are they?
Parenting Style and Behaviour Support
Parenting Style and Family Rules
Please describe your family’s approach to parenting and any key rules or guidelines you follow to support your child’s growth and development.
How does your child respond to challenging behaviour or difficult situations?
Please share any strategies or techniques that are helpful in supporting your child through moments of frustration or difficulty, including any tailored approaches for specific needs (e.g., ASD, ADHD)
What strategies do you use to help your child manage emotions and feel secure?
For example, do you use calming techniques, routines, or provide sensory support to help your child regulate emotions and feel safe?
Medical Information
Does your child have any allergies?
If yes, please specify:
What is the emergency procedure for their allergy?
Does your child have any medical conditions we should know about?
If yes, please provide details:
Does your child take any regular medications?
If yes, what medication and how should it be administered?
What is your child’s paediatrician’s name?

PrefixFirst Name (or "Doctor/Dr" if unknown)Last Name
What is your child’s paediatrician’s phone number?

Area CodePhone Number
What is your preferred hospital in case of an emergency?
Does your child have an individual action plan? If yes, please provide a copy via email.
Funding & Eligibility

If your family is eligible for NDIS and/or IHC, please note that a different pricing structure will apply.
Is your family eligible for In-Home Care (IHC)?
Is your child eligible for National Disability Insurance Scheme (NDIS)?
Permissions
Do you give permission for first aid to be administered to your child if needed?
Do you give permission for emergency services to be contacted in the event of a medical emergency involving your child?
Do you give permission for sunscreen to be applied to your child during outdoor activities?
Do you give permission for your child to be photographed for documentation purposes (not for public use)?
Do you give permission for medication or an EpiPen to be administered to your child if necessary?
Do you give permission for your child to attend local excursions? (e.g., park, library, shopping centre)
Do you give permission for Storypark to be used to share updates, routines, and photos of your child for documentation purposes?
Child's Goals (Applicable to All Bookings)

Please let us know any areas you would like us to focus on for your child’s development and well-being. You can provide specific goals or general areas of focus.
Social development
(e.g., making friends, group play, sharing)
Emotional Development
(e.g., managing big emotions, building confidence, emotional regulation)
Physical Development
(e.g., fine motor skills, gross motor skills, coordination)
Cognitive Development
(e.g., problem-solving, memory, focus)
Language and Communication
(e.g., vocabulary, expressive and receptive language skills)
Other Goals or Specific Focuses:
Additional Information
Please provide any additional information that will help us provide the best care for your child:
Parent/Guardian Signature

By signing below, you acknowledge and agree to the information provided in this enrolment form.
Full Name

First NameLast Name
Signature
Date

DayMonthYear
Date
Should be Empty:

Child Information

Primary Parent/Guardian Information

Secondary Parent/Guardian (if applicable)

Address for Care

Emergency Contact 1

Emergency Contact 2

Feeding Information

Nap and Sleep Information

Activities and Comfort

Parenting Style and Behaviour Support

Medical Information

Funding & Eligibility

Permissions

Child's Goals (Applicable to All Bookings)

Additional Information

Parent/Guardian Signature