Year Round Care Online Enrolment Form | Tamworth Regional Council

This form is to be completed BEFORE your child/ren can attend Year Round Care.

The information provided by you will be treated as strictly confidential and will not be used for any other purpose.

Parents are required to provide Customer Reference Numbers (CRN) for yourself and your child/ren.

Child/ren Enrolment Details

Family Name*

Given Name(s)*

Address*

Suburb / Postcode*

Child's CRN*

Date of Birth*

Gender*

Child's School*

Nationality*

Language/s Spoken*

Aboriginal/Torres Strait Islander

Religion*

Medicare Number*

Card Reference Number*

Parent / Guardian Information

Title

Full Name*

Street Address*

Suburb / Postcode*

Phone Number*

Mobile Number

Email Address*

Employer Name

Work Phone Number

Date of Birth*

Do you consent to Tamworth Regional Council updating their records with the information provided above?*

Family CRN*

Are there any family situations that we should be aware of?*

Yes

Parent / Guardian 2 - Information

Full Name*

Street Address*

Suburb / Postcode*

Phone Number*

Mobile Number

Employer Name

Work Phone Number

Collection / Emergency Contact

Persons collecting children from the centre MUST be 16 years of age or over. Any person not on this form will be refused collection unless prior arrangements are made with educators.

If custody orders apply, a copy must be kept on your child/ren's file.

The Medical Consent nominee is authorised to consent to medical treatment, or to authorise administration of medication to the child/ren.

These people may be asked to show identification.

Collection / Emergency Contacts

Contact's Full Name*

Relationship to Child*

Street Address

Suburb / Postcode

Phone Number*

Authorised Contact Type*

Emergency

Authorised Collection

Medical Consent

Authorised to authorise an educator to take the child outside the education and care service premises

Authorised to authorise the education and care service to transport the child or arrange transportation of the child

Family Doctor

Name of Treating Doctor

Name of Surgery

Address

Phone Number

Relevant Medical History

Has the child/ren been diagnosed or at risk of anaphylaxis?*

Yes

Please tick all that apply and provide further information in the space provided below. A Risk Minimisation Form may also need to be completed. Please see an educator for further information.

Allergies eg. Bees, food, grass etc

Behavioural Needs

Asthma - Action Plan required

Disability / Special Needs

Diabetes

Other - specific healthcare needs including a medical condition

Immunisation

Please provide an up-to-date copy of your child/ren's immunisation record. This MUST be provided before your child/ren can attend Year Round Care. If you are unable to upload a copy of your child/ren's record to this form, please ensure a copy is provided to the centre prior to your child/ren commencing care.

Immunisation history statements are available online using your myGov login. Click here to log in.

Copies may be uploaded in JPG or PDF format and each file must be 10MB or smaller.

Upload immunisation record from Blue Book (optional)

Service Access

Please specify the reason for child care

Work related care

Child/ren with special needs

Non-work related care

Special Considerations

Does the child/ren have any cultural or religious requirements?*

Yes

Does the child/ren have any dietary requirements/restrictions?*

Yes

Does the child/ren have any additional needs which may require special assistance? Eg. Early intervention, speech therapy, paediatric services, family support etc*

Yes

Are there any court proceedings or parenting plans relating to powers of duty and responsibilities?*

Yes

Service Requirements

Commencement Date*

Requirements*

After School Care

Before School Care

Vacation Care

Confirmation is required each term for Before School and After School Care.

Vacation Care bookings are taken from Week 8 each term.

General Information

Please provide any further information you would like us to know about your family and/or child/ren eg. Child needs to do homework before play

Do you have any special skills that you could bring to our service? eg. Coaching, sewing, handyman etc

Consent

I hereby give my permision for the educators at Year Round Care to seek medical attention for the above child/ren in the event of an accident/emergency. I understand that if an Ambulance is required, it will be at my cost, not the centre's. I give permission for my child to be transported by Ambulance if necessary. This may include medical treatment for the child by registered medical practitioner, hopsital or Ambulance.*

I hereby give my permission for the educators at Year Round Care to administer paracetamol, apply Stingose and bandaids for the above child/ren. A courtesy call will be made prior to administering Panadol*

I give permission for my child/ren to be involved in any photography or video taken for publicity purposes at Year Round Care*

I have read and agree to adhere to the Year Round Care Fee Schedule and agree to pay my fees on a regular basis. I agree to keep my fees below $200 per child.*

I have read and understood the Exclusion Policy and agree to keep my child excluded from the centre if presenting any of the illnesses stated in the exclusion policy.*

I understand that there is a Policy Manual kept in the sign-in area of each centre for parents and educators to refer to, and I agree to adhere to these policies or risk losing my child/ren's place in the centre.*

I give permission for the service to observe my child for programming purposes, to ensure the program reflects their individual needs and interests. All information gathered is confidential.*

I give permission for educators to collect my child from the school bus when arriving to After School Care and if using Before School Care to be put on the school bus, or walked to and from St Joseph's School.*

Declaration

All parents wishing to enrol their child/ren at Year Round Care must read and understand the Dealing with Medical Conditions Policy (PDF 193KB).

By checking this box I declare I have read and understood the Dealing with Medical Conditions policy.*

Privacy Statement

Any personal information you have supplied to or is collected by Tamworth Regional Council will only be stored and processed by Council for lawful purposes directly related to the functions and activities of Council. Any personal information supplied will only be disclosed to a third party for the purpose of performing a lawful function or activity and for no other purpose. Disclosure of personal information to a third party will be in accordance with Tamworth Regional Council's Privacy Management Plan (PDF 331.7KB).

Mandatory field(s) marked with *