Enrolment

Complete the form below to enrol your child at Little Babes Early Learning Centre and Kindergarten. Fields marked * are required under the Education and Care Services National Regulations. We'll be in touch to confirm next steps and arrange payment of the enrolment fee.

Service name: Little Babes ELC
Address: 42 Kings Rd, St Albans VIC 3021
Phone: (03) 9362 1488
Email: littlebabes@optusnet.com.au

Child's Photo

Please attach a passport-size photo of your child

Required Documents

Please attach the following documents to your application before submission. If a document doesn't apply to your family, leave it blank.

Child's birth certificate / identity documents

AIR Immunisation History Statement

ASCIA Action Plan (Anaphylaxis / Asthma)

Medical Management / Risk Minimisation / Communication Plan

Family law or other relevant court orders / legal documents

Photo identification of emergency contacts

Child Details

Family Name *

First Given Name *

Second Given Name

Preferred First Name

Date of Birth *

Gender *

Child's Centrelink Reference Number (CRN)

Child's Home Address *

Child Normally Lives With *

Days of Attendance *

Enrolment fee $100.00 (non-refundable). Daily fee $155.

Child's Start Date *

Cultural Consideration & Early Start Kindergarten

Is your child of Aboriginal or Torres Strait Islander origin? *

No Aboriginal Torres Strait Islander Both

Has the child's family had contact with any of the following services?

Child protection services Child First Orange Door None of the above

Is the child, parent or guardian a refugee or asylum seeker?

Is the child currently in an Out of Home Care arrangement? *

Yes No

Does the child have a diagnosed disability? *

Yes No

Does your child speak a language other than English at home? *

Yes No

If yes, what language(s)?

Country of Birth

Child's Residency Status

What is your child's cultural background?

Please outline any cultural practices you would like followed (cultural, dietary)

Religion

Relevant religious/cultural practices or celebrations you would like followed

Primary Parent / Guardian

The Primary Parent must also be the registered CCS claimant.

First Name *

Surname *

Address *

Phone (Home)

Phone (Mobile) *

Phone (Work)

Date of Birth *

Email Address *

Relationship to Child *

Country of Birth

Languages Other Than English Spoken at Home

Parent Centrelink Reference Number (CRN)

Please provide any relevant cultural background details

Does the child normally live with you? *

Yes No

Occupation

Secondary Parent / Guardian

Leave blank if not applicable.

First Name

Surname

Address

Phone (Home)

Phone (Mobile)

Phone (Work)

Date of Birth

Email Address

Relationship to Child

Country of Birth

Languages Other Than English Spoken at Home

Parent Centrelink Reference Number (CRN)

Please provide any relevant cultural background details

Does the child live with you?

Yes No

Occupation

Family Law, AVOs or Other Relevant Court Orders

Are there any relevant court orders, parenting orders or parenting plans relating to the child? *

Yes No

Are there any other relevant court orders relating to the child's residence or contact with a parent?

Yes No

Have photographs and names of unauthorised people been attached to this form?

Yes No

Briefly outline any court order requirements

Please note that without supporting documentation we cannot legally enforce the Order/s — attach copies above under Required Documents.

Medical Information

It is essential that you inform us of any medical conditions, including known allergies, before enrolment. Contact management as soon as possible if this information changes.

Child's Medicare Number

Medicare Expiry Date

Child's Medicare Reference Number

Doctor's Name

Medical Centre

Doctor's Phone Number

Doctor's Address

Dentist Name

Name of Service

Dentist Phone Number

Dentist's Address

Private Health Cover

Yes No

Private Health Fund Name

Private Health Care Membership Number

Ambulance Cover *

Yes No

Has the child's Health Record been sighted (Blue Book or other relevant health records)?

Yes No

Allergies & Anaphylaxis

Does your child have any allergies (insect stings, food, animals, latex, medication or other)? *

Yes No

Allergy to

Medical Specialist / Doctor Treating This Condition

Phone Contact

Address

Risk of Anaphylaxis

Yes No

Has a doctor diagnosed this allergy?

Yes No

Does your child have a current ASCIA Action Plan?

Yes No

Has your child been prescribed an adrenaline autoinjector (EpiPen)?

Yes No

Adrenaline Autoinjector Expiry (Month/Year)

A Management/Risk Minimisation/Communication Plan has been completed for allergies or anaphylaxis

Yes No

Does your child have any special dietary requirements or restrictions?

Yes No

Prohibited Food / Detailed Information

Other Medical Conditions (Asthma, Epilepsy, Diabetes, Other)

Medical Condition

Has a doctor diagnosed this condition?

Yes No

Does your child have a current Action Management Plan (e.g. Asthma Plan)?

Yes No

A Management/Risk Minimisation/Communication Plan has been completed for this condition

Yes No

Does your child take any prescribed regular medication for this condition?

Yes No

Medication Name/s

Immunisation Details

No child can be enrolled unless evidence is provided of up-to-date vaccination from the Australian Immunisation Register (AIR).

Immunisation Status of Child at Enrolment *

AIR Immunisation History Statement provided, recorded 'up to date'?

Yes No

AIR Medical Exemption Form provided (medical contraindication / natural immunity)?

Yes No

AIR Immunisation History Form completed with a 'catch up' schedule initiated?

Yes No

Family Information

Siblings attending our Service (names and ages)

Siblings at home or attending school (names and ages)

Other close relations attending the Service (names and ages)

Developmental Information

Does your child have any problems with hearing, sight or speech?

Physical disability or delay (intellectual, sensory or physical impairment)?

Does your child require additional support for learning because of disability?

Anything you do or modify at home that may assist us to meet your child's educational needs?

Has your child begun toilet training?

Is this the first time your child has been in care?

Yes No

If not, what type of early education and care has your child experienced?

Is your child used to being with other adults and children?

Yes No

Does your child have any comforters? (security blanket, dummy, bottle etc.)

Transition to School

Have you decided what school to send your child to?

Yes No

Name of School

Do you give the Service permission to exchange information with the school to assist your child's transition?

Yes No

First Emergency Contact — Authorised Nominee

Must live a maximum of 30 minutes from the Service and must provide identification when collecting the child. Please obtain their consent before listing them.

Full Name *

Relationship to Child *

Phone (Mobile) *

Phone (Home)

Phone (Work)

Address *

Email Address

Can this person deliver/collect your child? *

Yes No

Can this person consent to medical treatment / medication administration if you can't be contacted?

Yes No

Can this person consent for educators to take the child outside the Service's premises?

Yes No

Second Emergency Contact — Authorised Nominee

Full Name *

Relationship to Child *

Phone (Mobile) *

Phone (Home)

Phone (Work)

Address *

Email Address

Can this person deliver/collect your child?

Yes No

Can this person consent to medical treatment / medication administration if you can't be contacted?

Yes No

Can this person consent for educators to take the child outside the Service's premises?

Yes No

Authorisations — Illness, Accident & Emergency Treatment

Authorise seeking medical treatment from a registered medical practitioner, hospital or ambulance service? *

Yes No

Authorise seeking dental treatment in an emergency? *

Yes No

Authorise arranging transportation (including ambulance) in an emergency? *

Yes No

Authorise administering paracetamol or ibuprofen for a temperature of 38°C or higher? *

Yes No

Authorise applying SPF30+ sunscreen prior to sun exposure? *

Yes No

Authorise applying Band-Aids or sticking plasters when necessary? *

Yes No

Authorise applying nappy cream/paste supplied by parents? *

Yes No

Authorise applying insect repellent supplied by parents? *

Yes No

Photography & Video Consent

Photos/video taken for Service use and staff training purposes (footage will not leave the Service)? *

Yes No

Photos/video used in Learning Stories and shared with other families at the Service? *

Yes No

Photos/video used for student training purposes (may leave the Service for lecturer/class review)? *

Yes No

Photos/video used on the Service website, social media and other internet/marketing purposes? *

Yes No

Parent Agreement

Please tick each box to confirm you have read and agree to each point. All are required to complete your enrolment.

I agree to inform the Service in writing immediately of any changes to the above information. I agree to pay the Service enrolment fee and am aware that it is non-refundable. I agree to keep my fees paid up to date, understanding all booked days are paid for even when my child is absent. If unable to collect my child by closing time, I will organise for an emergency contact to collect them. I agree to pay a late fee of $15.00 per 15-minute block or part thereof after closing time. I agree to provide two weeks' written notice to withdraw my child or reduce booked days. I give permission for prescribed medication to be administered per the Service's Administration of Medication form, and agree to inform staff verbally and in writing of medication needs. I give permission for my child to be observed by educators and supervised practicum students. I have read the Family Handbook and Policy Manual and agree to follow, support and abide by these policies.

Anything else we should know?

Signatures

I have read and understood the information in this application. Information provided about my child/ren or other people has been given with their authorisation. Type your full name below as your electronic signature.

Parent 1 — Print Name *

Parent 1 — Signature (type full name) *

Parent 1 — Date *

Parent 2 — Print Name

Parent 2 — Signature (type full name)

Parent 2 — Date

How Did You Hear About Us?

How did you hear about us? *

If other, please specify

Privacy Disclaimer

We acknowledge and respect the privacy of our clients. The enrolment information collected assists us to meet our legislative obligations and provide the best level of education and care for your child. By completing this form, you consent to this information being collected and used by educators/staff and relevant government authorities. You have the right to access and alter personal information concerning yourself or your child in accordance with the Privacy Act 1988 and our Privacy and Confidentiality Policy.

I have read and agree to the Privacy Disclaimer above. *