Our office will be closed from 3.00pm on Friday 21st December 2018 and will return at 9.00am on Monday 7th January 2019.

Wishing you a Merry Christmas & a Happy New Year!

 

Download and print a pdf ENROLMENT FORM here

 

1. Information about the child

NOTE! if you leave a field blank please put N/A in the field

Child’s Customer Reference Number (CRN): (Obtained from the DHS)

First Name:

Middle Name:

Last Name:

Date of Birth: (yyyy-mm-dd)

Gender:  Male Female

Does your child attend pre-school/school/other service (e.g. Long Day Care):  Yes No

If yes, please indicate name of school / other service:

Country of Birth:

Languages spoken at home:

Is your child of Aboriginal or Torres Strait Islander origin (please select one):
 No Yes, Aboriginal Yes, Torres Strait Islander Yes, both Aboriginal & Torres Strait Islander

Religion ( if applicable):
Please provide any info (if any) concerning child’s religion and cultural background?

Does the child have any special needs (please tick): Yes No
If Yes please complete the following:
Communication: Yes No
Mobility: Yes No
Self-Care: Yes No
Social interactions & relationships:
Other:

Is the child from (please select): A culturally & linguistically diverse background:  Yes No

A refugee background who have been subjected to trauma:  Yes No

The child’s place has been sought by a state or territory child protection worker:  Yes No

The child is in care of the state, or other forms of out of home care:  Yes No

If yes, please explain:

Immunisation: All parents claiming Child Care Subsidy for children must provide proof of immunisation to the DHS (Department of Human Services), or register as a conscientious objector. Please note that confirmation of immunisation needs to be given to the Family Day Care office upon enrolment and each time immunisation is updated. Is your child immunised (please tick):  Yes No Partially

Does your child have any allergies or sensitivities including asthma and/or anaphylaxis?:  Yes No
If yes, please attach a medical action plan supplied by a doctor.

Does your child have any medical conditions?  Yes No
If yes, please attach the
(e.g. epilepsy, diabetes, deafness, heart murmur etc) child’s management procedure to be followed.

Does your child have any additional needs or disability?  Yes No If yes, please provide (e.g. cerebral palsy, autism, ADHD etc) details and/or medical reports.

Does your child have any dietary restrictions, sensitivities  Yes No If yes, please provide a list or mild allergies? Skin, hay fever etc of the restrictions in writing.


2. Information about the child’s parents/guardians:

Parent / Guardian 1 – person claiming CCS.

Customer Reference Number (CRN): (Obtained from the DHS)

First Name:

Middle Name:

Last Name:

Preferred Name:

Relationship to the child:

Does the child live with you?  Yes No Shared Care

Date of Birth: (yyyy-mm-dd)

Gender:  Male Female

Home Address:

Postcode:

Postal Address (if different from home address):

Phone:

Mobile:

Email:

Work / Study:  Full Time Part Time Casual Self Employed Student Home Duties

Employer / Place of study:

Occupation:

Work Phone Number:

Country of Birth:

Languages spoken at home:

Ethnic Group (please select):
 No Yes, Aboriginal Yes, Torres Strait Islander Yes, both Aboriginal & Torres Strait Islander

Parent / Guardian 2.

Customer Reference Number (CRN): (Obtained from the DHS)

First Name:

Middle Name:

Last Name:

Preferred Name:

Relationship to the child:

Does the child live with you?  Yes No Shared Care

Date of Birth: (yyyy-mm-dd)

Gender:  Male Female

Home Address:

Postcode:

Postal Address (if different from home address):

Phone:

Mobile:

Email:

Work / Study:  Full Time Part Time Casual Self Employed Student Home Duties

Employer / Place of study:

Occupation:

Work Phone Number:

Country of Birth:

Languages spoken at home:

Ethnic Group (please select):
 No Yes, Aboriginal Yes, Torres Strait Islander Yes, both Aboriginal & Torres Strait Islander


Court Order / Parenting Order or Plan (contact, residence, AVO etc).  Yes No
If yes, please explain:
Please attach a copy of any orders relating to the child.


Photo Authorisation: Whilst your child is in BBFDC, photos may be taken. Do you give permission for these photos to be used for: Training Purpose  Yes No
Promotional Use  Yes No
Educators to document learning experiences, development for the albums  Yes No
Email purposes
BBFDC Web site  Yes No


I request to receive the quarterly parent statements via:  Email Post Not to receive


Access Authorisation: I give authority for the child referred to in this confidential record nominate the following person/s as contacts as follows:

Contact 1:

Full Name:

Gender:  Male Female

Address:

Email Address:

Home Phone:

Work Phone:

Mobile Phone:

Relationship to child:

Please tick the box/es below to confirm the level of authorisation you give to this person:
 Consent to collect (authorised nominee) Authorise to be notified of an emergency involving the child if any parent/guardian cannot be contacted Consent to medical treatment Consent to administration of medication Authority to authorise an educator to take the child outside the service on excursions/regular outings Authority to authorise an educator to take the child outside the service premises

Contact 2:

Full Name:

Gender:  Male Female

Address:

Email Address:

Home Phone:

Work Phone:

Mobile Phone:

Relationship to child:

Please tick the box/es below to confirm the level of authorisation you give to this person:
 Consent to collect (authorised nominee) Authorise to be notified of an emergency involving the child if any parent/guardian cannot be contacted Consent to medical treatment Consent to administration of medication Authority to authorise an educator to take the child outside the service on excursions/regular outings Authority to authorise an educator to take the child outside the service premises

Contact 3:

Full Name:

Gender:  Male Female

Address:

Email Address:

Home Phone:

Work Phone:

Mobile Phone:

Relationship to child:

Please tick the box/es below to confirm the level of authorisation you give to this person:
 Consent to collect (authorised nominee) Authorise to be notified of an emergency involving the child if any parent/guardian cannot be contacted Consent to medical treatment Consent to administration of medication Authority to authorise an educator to take the child outside the service on excursions/regular outings Authority to authorise an educator to take the child outside the service premises


Health Details:

Doctor:

Name:

Address:

Phone Number:

Medicare Number:

Number beside your child’s name on card:

Health Details:

Dentist:

Name:

Address:

Phone Number:


PARENT’S AUTHORISATION:

1. I accept the policies and procedures set down by BBFDC and agree to abide by these conditions, I understand that BBFDC policy manual is available for viewing at all times. I also understand that I will be provided with a parent booklet regarding Ballina Byron Family Day Care (BBFDC).

2. I agree in order to be eligible for Australian Government fee assistance (e.g. CCS), the care arrangement and all associated invoices, receipts and statements must make clear that the care is being provided by the service and that the fees are being paid to the service.

3. I agree to abide by the conditions outlined in the Educators Individual Fee Schedule and Parent/Educator Agreement regarding payment of fees, food provisions and other arrangements as contained therein.

4. I agree to notify the Family Day Care office (ph 6686 7799) of any changes in the agreed hours or days of care and to sign the relevant forms pertaining to this.

5. I agree to record and initial actual arrival and departure times on attendance records, as required by the Department of Education, Employment and Workplace Relations, as an accurate record of actual hours of attendance. I agree to sign the attendance record stating this is an accurate record of hours for which payment is to be made.

6. I am aware that full fees are to be paid if my Child Care Subsidy (CCS) is cancelled or waiting processing by the Department of Human Services (DHS).

7. I agree to keep receipts issued to me by the educator as a record of fees paid.

8. I authorise the Co-ordination Unit to deduct the amount of Parent Levy paid by myself to the educator.

9. I understand my child will be visited by a scheme Co-ordinator who will observe the developmental progress of my child at regular intervals and make referrals to other agencies if required with my consent.

10. I agree to supply immunisation records (ACIR statement) to the Family Day Care Office each time my child’s immunisation is updated. Please be aware as per Parent Booklet as directed by Public Health Unit.

11. In case of accident or other emergency resulting in the need of immediate medical, hospital or dental treatment, if parent/guardian not contactable, I hereby give my consent for the educator to contact an ambulance or arrange for my child to be seen by his/her doctor or failing that the nearest hospital, medical or dental service available. I agree to pay all costs incurred.

12. I agree that in an emergency situation or drill where evacuation is necessary that my child may need to leave the service under the direction and supervision of the educator.

13. In case of my child contracting an infectious disease, I agree to exclude him/her from the family day care home for a period, recommended by the NSW Dept. of Health, and to pay the regular childcare costs as a holding fee for my child’s placement.

14. I understand that parent permission notes are to be signed for each excursion outside the educator’s home. Routine excursion forms can be signed for yearly, e.g. playgroup, library visits, park, school drop-offs and pick-ups. All families are to be informed prior to outings undertaken by the educator under all circumstances. I agree to pay all costs of excursions and outings to the educator in addition to regular fees if applicable.

15. I agree to provide accessible emergency contact details to my educator as an alternate option to the parent/guardian in case of an emergency and the parent/guardian cannot be contacted.

16. I understand that Family Day Care placements operate according to Department of Education, Employment and Workplace Relations Priority of Access Guidelines and that I may be asked to vacate my position for someone on a higher priority.

17. A parent enrolment fee of $60.00 is payable upon enrolling for care with the scheme. This fee is non-refundable. Payment can be made at the Ballina Office (17 Brunswick Street), or via post (P.O. Box 807, Ballina 2478) or direct debit payment to Westpac Bank (BSB No: 032 591, Account No: 360 599 – If choosing this option please quote your family surname as a reference).

I agree to the above terms and conditions and authorise this enrolment
I agree:
Full Name:


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