Hornsby Heights Pre-School Kindergarten

28 Galston Road Hornsby, NSW 2077
Telephone 9987 4896 Hours 7.30 AM – 6.00 PM
www.hhpk.com.au
info@hhpk.com.au

ENROLMENT APPLICATION

(All information supplied on this form is treated as confidential)

Main Contacts

Primary Parent/Guardian

Name

Relation to Child

Mobile No

Home Phone

Occupation

Place of Work

Work Phone

Email

Address

Date of Birth

Country of Birth

Languages Spoken (Separate by commas)

CRN

(CRN information is only required for Child Care Subsidy (CCS))

Authorization

Collection
YesNo

Emergency
YesNo

Excursion
YesNo

Incursion
YesNo

Medical
YesNo

Secondary Parent/Guardian

Name

Relation to Child

Mobile No

Home Phone

Occupation

Place of Work

Work Phone

Email

Address

Date of Birth

Country of Birth

Languages Spoken (Separate by commas)

Authorization

Collection
YesNo

Emergency
YesNo

Excursion
YesNo

Incursion
YesNo

Medical
YesNo

COLLECTION OF YOUR CHILD

Please nominate two people who you authorise to collect your child if both parents/guardians are unavailable. These people are authorized to consent medical treatment, Consent to transportation of child by an ambulance service/ administration of medication and permit an educator to take your child outside education and care service premises (if both parent/guardians are uncontactable).

Authorized Nominee 1

Name

Relation to Child

Contact Phone Numbers

Home

Work

Mobile

Nominee 1 Signature

Authorized Nominee 2

Name

Relation to Child

Contact Phone Numbers

Home

Work

Mobile

Nominee 2 Signature

EMERGENCY CONTACTS

Please nominate two people who you authorize to act as emergency contacts if both parents/guardians are unavailable. These persons may also consent to medical treatment for your child, should you not be contactable. Please note: “The emergency contacts” you nominate below are NOT permitted to remove your child from the premises unless they have also been nominated to collect your child as above.

Same as “Collection of your child contact #1?
YesNo (If not please complete other emergency contact details)

Child Information

First Name

Last Name

CRN

Gender
MaleFemale

Languages Spoken at Home

Secondary laguage

Cultural Background

Child Primarily Lives With

Child's Address

Date of Birth

Copy of Birth Certificate

Is your child Aboriginal or Torres Strait islander?
YesNo

Family Permits Photographs of my child for the educational programming and assessments?
YesNo

If your child will be chosen for observations on training purpose, do you give your permission to take photograph?
YesNo

Days Required
MondayTuesdayWednesdayThursdayFriday

How Many Days Per Week
2345

Proposed Start date

Health & Safety

Although every possible care will be taken with your child at our service, the Educators can in no way be held responsible for any accident that may occur. In the event of an accident or illness, requiring emergency Medical, Hospital or Dental treatment, every effort will be taken to contact the parents.
I agree that if my child has been injured, become ill whilst at the service, the approved provider, a nominated supervisor, or an educator is allowed to seek

medical treatment for the child from your nominated medical practitioner, hospital or ambulance service and transportation of the child by an ambulance
YesNo

Does your child suffer from any recurring skin disease?
YesNo

Has your child had any serious illness in the past?
YesNo

Has your child ever been hospitalized?
YesNo

Does your child currently have any serious illness?
YesNo

Does your child have a medical condition?
YesNo

Does your child have any additional needs, e.g., undergoing assessment, attending speech therapy, receiving support from an early intervention service or any other therapy?
YesNo

Does your child require any medical procedures to be performed on a regular basis?
YesNo

Is your child receiving regular medication?
Yes (if so provide additional information)No

Does your child have Asthma?
YesNo

Anaphylaxis?
YesNo

Does your child have any allergies?
YesNo

Please provide a current copy of the Australian Immunisation Register (AIR)

Copy of AIR

Does your child have a conscientious Objection?
YesNo

Name of health fund (If any)?

Medicare Number

Does your child have a Dentist?
YesNo

Are there any special Religious/Cultural requirements is case of accident/illness?
YesNo

Do you have any concerns about your child’s development?
YesNo

Has the child been assessed by a healthcare professional?
YesNo

Family & Child Information

Parents Please complete Family & child Information Summary which provides some background to us about the family and child/ren.

Information on Child’s Interest

Needs, likes and dislikes

Goals for the Child

Food Preferences

Routines at Home

Toilet Training Needs

Names of family members and pet/s

Court Orders

Are there any court orders or parenting plans which relate to your child?
YesNo

Please note that without this documentation we cannot legally enforce the Order/s.

Additional Information

Any information you feel the service should know about the child e.g., cultural, religious, or dietary requirements or additional needs?
YesNo

NSW

More information is available at:
www.health.nsw.gov.au/immunisation/pages/vaccination
https://www.health.nsw.gov.au/immunisation/pages/default.aspx

Other Children in the Family

Nominated CCS hours.

Does your child attend another CCS approved service?
YesNo

Families are responsible for updating Centrelink with any changes to their income, activity, and other circumstances.

Transition to School

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

Parents statements: Please tick to confirm you understand each point. Please ask if there is anything you are unsure of

I agree to inform the Service in writing immediately of any changes to the above information.

I agree to pay a deposit (Bond) of $300 on enrolment ( BANK DEATAILS : Account Name: Hornsby Heights Preschool, BSB:062-401, Account No: 1025 2367). The deposit will be refunded after recovering any arrears when my child leaves the service. If I change my mind and decide against sending my child, the deposit (Bond) will not be refunded.

I acknowledge at enrolment fees per day is

I agree to keep my fees paid up to date and understand that my child’s position at the service will be in jeopardy if my fees are not kept up to date.

If I am unable to collect my child by closing time, I will organise for one of the people listed as authorise nominees to collect my child prior to closing time. I am aware that if my child has not been collected by closing time, and if I am unable to be contacted, those persons nominated as authorised nominees will be called by service educators to collect my child.

I agree to pay a late fee of $1 per minute, after closing time. If a child is left at the service for over an hour after closing and service educators have been unable to contact anyone to collect the child, we will notify The Department of Family and Community Services and may be required to take the child to the local Police Station to await your arrival. A note will be left detailing the child’s whereabouts.

I agree to give four weeks written notice to withdraw my child.

I agree to give two weeks’ notice to reduce days.

I agree to bring my child to the Service with sunscreen applied and give permission for educators to reapply sunscreen throughout the day. (if your child has sensitive skin and would prefer, they use their own sunscreen please bring a spare tube to remain at the Service – clearly labelled with your child’s first and last name).

I give permission for prescribed medication to be administered by Service primary contact staff upon my authorization on the Service’s medication form. I understand that if details are filled in incorrectly or left blank or if the medication does not meet the standards of the Service’s policy the medication will not be given unless, in the case of missing or incorrect details I can be contacted to authorize the missing details. I agree to inform the educators both verbally and in writing of the need for medication for my child. I understand that non-prescription medication will not be given by educators unless it is accompanied by a current (within 6 months) dated Doctors letter stating the name of and reasons for the medication.

I agree my rude, aggressive, unacceptable, and intimidating behavior towards the service will compel the Management to terminate my child’s enrolment effective immediately.

I agree to abide by the conditions of the service and this contract. My contact details can be forwarded to a collection agency if my account is not paid before leaving the centre. All cost associated with collection will be added to my debt.

How did you hear about us?
Word of MouthInternet SearchWebsiteOther

Privacy Disclaimer

We acknowledge and respect the privacy of its clients. The enrolment information that is collected assists us to meet our legislative obligations and to provide the best level of education and care for your child. By completing this form, you have consented to this information being collected. The information will be used by educators/staff members 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.

At the point of initial contact, parents will be emailed the Parent’s Handbook.

For office use only