Kids Domain STOKES VALLEY - Before and After School Care Enrolment

KIDS DOMAIN

BEFORE & AFTER SCHOOL CARE ENROLMENT

Please SELECT N/A or TYPE N/A if something does not apply to you (1 child per form)
Centre to be Enrolled *
Child *

First Name Last Name
sex of child *

female male
Date of Birth *

Day Month Year
Child's Mobile Number (if they have one)
School Attending *
Classroom/Teacher's Name *

Mother/Caregiver *

First Name Last Name
Home Address *
Home Phone *
Mobile Phone *
Work Phone *
Are you working/studying? *
Employer/Company *
Work Email

Confirmation Email example@example.com
Name of institution where you are studying *
Father/Caregiver *

First Name Last Name
Home Address *
Home Phone *
Mobile Phone *
Work Phone *
Are you working/studying? *
Employer/Company *
Work Email

Confirmation Email example@example.com
Name of institution where you are studying *
Email address for billing *

Confirmation Email

In the event of an emergency including civil defence....

If we are unable to contact you (the parent/caregiver) for any reason, who are the best people to contact? (At least TWO emergency contacts are required)

These people are authorised to collect my child.

NO child will be allowed to be let go to somebody that is not listed below unless you have made contact with us to let us know, so please list as many as you wish especially in the event a civil defence matter occurs and phone lines maybe down
1st Emergency Name *
Relationship to Child *
Contact Ph Number(s) *
2nd Emergency Name *
Relationship to Child *
Contact Ph Number(s) *
3rd Emergency Name
Relationship to Child
Contact Ph Number(s)
4th Emergency Name
Relationship to Child
Contact Ph Number(s)
5th Emergency Name
Relationship to Child
Contact Ph Number(s)
6th Emergency Name
Relationship to Child
Contact Ph Number(s)
7th Emergency Name
Relationship to Child
Contact Ph Number(s)

ARE YOU APPLYING FOR A WINZ SUBSIDY? *
METHOD OF PAYMENT *
Documents you would like to attach (includes winz forms)
You have selected you are applying for a winz subsidy - PLEASE READ IMPORTANT INFO BELOW Winz applications need to be recieved by Kids Domain within 2 working days of this booking to be processed before care can commence Application forms are available to download from our website www.kidsdomain.biz (go to winz subsidy page) or hard copies are available at the centre We accept applications scanned/emailed to us for processing if you are unable to make a time to come in - please make sure you have fully completed your form If you are working a recent payslip or letter from your employer MUST be attached to your winz application. Winz will not process without this. A non-refundable deposit of 1 weeks care is due upon reserving the placement and payable in advance of care commencing. Winz do not backdate payments if your form has been returned late. If you are unable to get to a winz office we are happy to do this for you as long as we recieve your completed forms before care starts IMPORTANT DATES TO REMEMBER: 4 weeks before the end of every school term you will recieve a winz declaration form in the mail. This needs to be completed and handed into Kids Domain by our cut off date for processing. If you do not recieve one please ask a supervisor for a hard copy. Annually you will recieve a review of childcare form. this needs to be signed off by Kids Domain for processing. We are happy to have these sent off to winz for you. Failure to have your winz paperwork in by our cut off and/or up to date will result in childcare being suspended. *

YES, I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS
Policies and Procedures click here
PARENT CONTRACT I wish to enrol my child in your Out of School Care and Recreation Service. I acknowledge and agree to the following conditions: All children, including those attending casually must be formally enrolled. Parents/Caregivers are to sign their child/ren in and out of the programme every day they attend. Written consent must be given if their child/ren has permission to walk, bike or catch a bus home, this can be noted on the enrolment form, otherwise a phone call or a text to a supervisor giving permission is acceptable. If your child has other activities on after school, please notify a supervisor as soon as possible advising where the activity is, what time the child/ren is expected at after school care if they are returning. Only persons appropriately identified on the enrolment form will be allowed to pick up a child unless Supervisors have been previously advised, preferably in person or by phone call/text. CLOSING AND LATE PICKUPS All children attending after school care are to be collected before closing of each day Lower Hutt centre closes at 5.50pm Stokes Valley centre closes at 6.00pm A penalty will be charged for failure to collect children by this time as per the Fees Policy - $20 for the first 15 minutes (5.50pm-6.05pm) (6.00pm – 6.15pm) & $20 per 5 minutes after that. TYPES OF BOOKINGS: Casual placements are a one off bookings and the fee not payable if you do not use care (there is no guarantee we are able to take your child on the day of booking so you will need to check with a supervisor). Permanent bookings are placements booked for the same days each week and payable regardless of absence (and is at a discounted rate). Permanent bookings automatically roll over each term/year until notice is given (refer to notice). ABSENCE On each occasion that your child/ren will not be attending, Supervisors must be informed as soon as possible especially if they are using the transportation service. Children who have permanent placements will still be charged for the space booked regardless of absence, this fee is still payable on public holidays, sick days, teacher only days, strikes etc. NOTICE OF ABSENCES: If your child will be away for 6 or more consecutive days a holding fee of 50% of your fees will apply to keep your placement (this can be done up to 1 month) 14 days notice is required. To give notice you must complete the form on our website https://www.kidsdomain.biz/Change-of-Bookings-Notice-Form/ and this will be recorded on our files by administration. A copy of your notice will automatically be emailed to you once you submit the form. CHANGES TO BOOKINGS: Examples of this are cancelling a day, booking a new day 14 days notice must be given to Kids Domain advising dates of changes. To give notice you must complete the form on our website https://www.kidsdomain.biz/Change-of-Bookings-Notice-Form/ and this will be recorded on our files by administration. A copy of your notice will automatically be emailed to you once you submit the form. PERMANENTLY CANCELLING CARE: If care is no longer required 14 days notice must be given to Kids Domain advising final date of care. To give notice you must complete the form on our website https://www.kidsdomain.biz/Change-of-Bookings-Notice-Form/ and this will be recorded on our files by administration. A copy of your notice will automatically be emailed to you once you submit the form. A final account will be emailed to you. SUSPENSION OF CARE: if your child’s care is suspended by Kids Domain, for example behavioural issues or an overdue account, the weekly fee is still payable. MEDICAL: I allow supervisors to administer panadol/paracetamol to my child/ren if it is required and any urgent medical treatment at my expense. BEHAVIOUR: It is ultimately my responsibility to ensure that my child/ren acts in an appropriate manner while at Kids Domain. I will pay for damage caused by my child/ren. Behaviour which consistently affects the quality of care available to other children may result in suspension or removal from the programme as set out in the Behaviour Management Policy. TRANSPORTATION: I give consent/permission for my child/ren using the transportation service provided by Kids Domain and go on pre-arranged outings. ACCOUNT DETAILS: A deposit of 2 weeks care is due upon reserving the placement and payable in advance of care commencing (this will be held as your 2 weeks notice). No refunds will be given if the booking is cancelled prior to starting. To give notice you must complete the form on our website http://kidsdomain.biz/Change-of-Bookings-Notice-Form/ and this will be recorded on our files by administration. Invoices are emailed out weekly via our automatic invoicing system for that week of care. Accounts must be paid weekly or in advance if you are paid fortnightly or monthly. ACCOUNT DETAILS: Kids Domain, ANZ Bank, 06 0545 0282917 00 - please use your child’s first/last name as reference/particulars. Cheques will not be accepted. All invoices/statements are emailed. If you require these to be printed and/or posted there will be a fee of $1.50 each time. Accounts that are not paid on time will incur a $2.00 late payment fee each week outstanding until the account is zero balance. If your fees are 4 weeks in arrears, childcare will be suspended. Your placement will still be payable on suspension for up to one week. After that time, the placement will be given to another child waiting for a placement. Unpaid fees will be placed with a debt collection agency and/or department of courts where parents/caregivers will be liable for collection & court fees incurred. EMERGENCY CLOSURE OF CENTRES: we are required to close our centres in certain circumstances that are out of our control, and must evacuate the premises in such an event. In the event of an emergency closure, you will be required to collect your child as soon as possible. Fees are still payable for up to 5 working days if there is an emergency closure of the centre. SICKNESS: Please keep your child at home if they are unwell until recovered as we do not have the facility to look after sick children. If your child attending the programme becomes unwell we will contact you to collect your child as soon as possible. Please notify the centre if your child has been diagnosed with an infectious illness straight away. If your child has had vomiting or diarrhoea either at the centre or at home they will be excluded from the programme until they have been symptom free for 24hours. If you child has head lice please notify the centre. Your child’s hair will need to be treated before they can return. CHILDRENS PROPERTY: children are welcome to bring in toys, cellphones, tablets etc, but it is their responsibility not the staffs responsibility. OTHER INFORMATION: Please bring everyday - extra snacks and water bottle. During summer sunhats and sunblock everyday as these are not supplied. Supervisors will be advised of any situation which may be disturbing my child/ren. New enrolments will be automatically added to our mailing list. I will advise immediately any change in details contained in the enrolment form I understand that staff are police vetted, and have appropriate experience for the job they do and that Kids Domain complies with Health and Safety Policies and the National OSCAR standard. Photos/video/artwork may be used in a range of promotional materials, such as print and electronic media, including our websites/facebook page. Kids Domain and staff will be free and clear of all liability in the event of any injury as accidents do happen from time to time, damage or loss sustained by your child or to personal affects. A full copy of policies and procedures are available to read at each centre or online www.kidsdomain.biz/policies I have read, understood and agree to Kids Domains policies and procedures, the above terms, the booking information I have given is correct and this booking forms a legally binding contract between myself and Kids Domain. Our privacy policy is governed by the New Zealand Privacy Act 2020. If you voluntarily provide personal information (eg, through email feedback or online forms), we will keep that personal information secure and will not disclose it to any third party. Any personal information supplied will only be used for the purpose for which it was provided or permitted by the Privacy Act 2020 or otherwise required by law. Any information gathered may be viewed by the Ministry of Social Development for audit purposes, in line with the Privacy Act 2020, personal information required to be utilised that relate to any unpaid fees, can be passed to a debt collection agency and/or department of courts. *

YES, I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS
Full Name *

First Name Last Name
How did you hear about us? *
Date Signed *

Day Month Year
Once you hit the "SUBMIT FORM NOW BUTTON" your booking is complete and forms a legally binding contract between you and Kids Domain. Please check that the days you require and type of booking you have selected is correct before submitting
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