Is the Child of Aboriginal and or Torres Strait Origin? (please tick)
Does your child have a different primary language used at home other than English

BOOKING INFORMATION (Flexible Care -Minimum of one day Routine Care with the
option of additional Casual days as required/available)

Days Required (please tick)
Are you After Session Hours ?
If Yes
If you selected NO you are enrolling for the full 12 hr day
Is your child school age ?
If you selected NO you are enrolling for the full 12 hr day
If yes: - (tick where required)
If you selected NO you are enrolling for the full 12 hr day
If yes: - (tick where required)


Contact Details PRIMARY Parent/ Guardian – first person to contact

Contact Details SECONDARY Contact


Whilst we do the utmost to ensure the health and safety of all children in our care, there
may be times when a child is injured, sick or involved in an emergency and the parents
cannot be contacted. In case of such circumstances, please list TWO Emergency Contacts.

For security reasons we require new persons to bring ID with them until familiar with staff.

Is this person also authorized to collect your child?
Please read & Tick
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The following people (additional to the Emergency Contacts) are authorised to collect your child from our Service. Please note that personal identification will be required until staff are familiar with this person. Please not that you can add or amend this contact list.
This is for pick up/collection of child/ren only, not listed under emergency contacts
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Please provide any of the child's sibling or other people who live in your household:
If the parents are separated or divorced. please indicate if there is an official court order in regards to custody or access rights
If Yes, please provide a copy of the relevant Order or Access Plan. Please note that unless an official Court Order or Access Plan is sighted, we cannot by law refuse access to a child in care for a certain parent.
Does this Child currently attend school (SCHOOLIES PROGRAM)
Does your child have any allergies?
Has your child been diagnosed at risk of Anaphylaxis?

If yes please provide an action plan and an Epi Pen to be kept at the Service at all times. Staff will perform a risk assessment plan to minimise such a reaction. You will also be provided with our anaphylaxis management policy

Do you authorise the use of an ambulance service if we cannot contact you prior?

Please note that in regards to an Anaphylaxis Reaction or Asthma Attack, an ambulance will be called immediately and then we will contact you.
To be eligible for the Child Care Subsidy, your children must meet the immunisation
requirements if they are under the age of seven. To meet the requirements your child must
• Fully immunised or up-to-date according to the Australian Vaccination Schedule: or
• on a catch-up vaccination schedule
• you have an approved exemption for your child (see below)
Your child is exempt from immunisation under the below circumstances:
• you have been told by your doctor about the benefits and risks of immunising your
child and you have conscientious objection to immunising your child- your child's
doctor or a recognised immunisation provider will need to complete a "Medical
Contradiction" form ;or
• immunising your child with a particular vaccine is medically contraindicated ;or
• the child has a natural immunity to a certain disease or a vaccine is temporarily
unavailable; or
• you or your partner are a member of the Church or Christ Scientist and you have a
letter from an official of the Church advising that you are a practising member of the
Please provide a copy of your child/ren's current immunisation record provided by Medicare when enrolling or before child/ren’s start enrolment date.

CCS INFORMATION (Child Care Subsidy)
To ensure that you are linked to our Service through the Child Care Subsidy System (CCSS)
and have your Child Care Subsidy (CCS) to your child care fees, you must bring with you a
copy of your current CCS Assessment from the MyGov. If you do not have a current
assessment, please go to you MyGov account to attain one and record your current CCS
percentage and hours. By doing this, we will ensure that MyGov and Centrelink have your
correct personal information for e.g.: spelling of your name and D.O.B.
Please ensure that you fill out the following information correctly.
GUARDIAN/PARENT registered for CCS and Centrelink (must be the EXACT same details as MYGOV & Centrelink's records)

CHILD registered for CCS (must be the EXACT same details as MYGOV & Centrelink's

CHILD registered for CCS (must be the EXACT same details as MYGOV & Centrelink's

Has this child attended another child care service this financial year?
(ensure that you provided details in the child's details section)
Is this child attending more than one child care service this financial year?

Verification of details held by Centrelink
I confirm that:
1. The information above that I have provided is true and correct and I have provided Centrelink and MYGOV with the same information
2. I understand that I am responsible for communicating this information to Centrelink and MYGOV
3. I understand that I am responsible for all GAP fees from this enrolment
4. I understand that if any details are incorrect or have not been updated by myself to Centrelink or MYGOV, that any back dating of a CCS will result as a debt and I must pay the Service for this
5. I understand that if the information is not correct with Centrelink or MYGOV that I will be subject to pay full fees directly to the centre until the information is correct and updated.

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If you have other children who are registered for a CCS and are in care at another Service (this includes an OSHC Service), please complete the following information to ensure that we can apply a Multiple CCS to your account.

Details of other children in care (include children attending this Service):

Here at Regents Park Kindergarten & Child Care, we have a security system to stop un-invited guests into the centre.

To help us keep our centre secure, please keep the front door closed at all times and do not give your PIN code

We as educators strongly advise that your child arrives at the centre by 9:30am each day. This will ensure that your child will partake in the daily interests, activities and documentation.
Although we do offer experiences throughout the day, the children’s concentration and
engagement levels are best during the morning and this is when we mostly do our focus
sessions and documentation.
Your child’s profile, room and scrapbook will be full of tracking and an abundance of activities and photos.
It is however your choice as to when you send your child, we just want what’s best for all in the long run.

AGREEMENT AND CONSENT TO TERMS – Please read thoroughly before sign

1. Emergency or Accidents

In the event of an emergency, illness or accident (when the Centre is unable to contact the Parent / Guardian or the Authorised Contact/s), I / We give the staff at the centre consent to provide Medical or Hospital attention for our child. I /We agree to pay any expenses incurred for Medical treatment and Transport.

2. Administering of Paracetamol

I / We agree for centre staff and/or Nurse to administer ONE dosage of Paracetamol in the event of our child’s body temperature rising above 38°C. I / We understand that the staff and/or Nurse will make contact with either the Parents / Guardians or the Emergency Contacts to inform us that Paracetamol is being administered and discuss at the time further actions to take in the event that the temperature does not subside within an appropriate time frame.

3. Permission for Publication

I / We hereby give consent for our child’s photograph, name and age to be used for the room programming, Centre displays and/or publications (e.g. Newsletters). Where this information may be utilized outside of the Centre, further permission will be sought.

4. Permission for Observation

I / We give permission for our child to be observed for staff, student or visitor purposes. Students and visitors will be from ACCS edited training programs and will work in conjunction with your child’s caregivers. If questioning or testing is to be carried out I / we will be asked for further permission.

5. Fees / Payment of

Please refer to our current fee schedule displayed in the Foyer for up to date fee information. As fees may change
all fee changes will be notified via notices on Statements and displayed in the foyer with fourteen (14) days notice.
I / We agree to maintain our fees as per the centre’s fee policy. We will ensure our fees are kept up to date by
making payments on the required day via Debit Success or as agreed with the Centre. I / We are aware that
failure to pay due fees within 14 days may result in the cancellation of care at the Centre’s option. Where a Debit
Success (direct debit) arrangement has been entered into, I/we authorize the centre to make withdrawals from
my/our nominated account as specified in the Direct Debit Request Form, as determined the centre in
accordance with the terms and conditions herein and in any subsequent agreement with the centre. I/we
acknowledge that such withdrawals may include amounts representing any arrears that are owed by me/us. I /
We understand that any costs incurred by the centre in collecting any arrears owed may be charged to my/our
account. I also understand and agree that if my bookings are cancelled due to an overdue account that all
unsettled debt will be referred to a Debt Collection Agency, this will also incur a 30% surcharge on my final
account. The details of this debt may also be placed on a credit reference bureau.
The information that may be passed to the collection agency, may include:-
- The name and address (and the previous two address’s), date of birth, name of employer, CRN number
and driver’s license number of the defaulter
- That you have been provided credit to the defaulter
- Details of any account that is overdue by more than 60 days, and for which debt recovery has
- The status of past overdue accounts (even after they are settled)
- Whether any dishonoured cheques drawn buy the defaulter for $100.00 or more which have been
dishonoured more than once.
Further court action will be taken and I/We will be liable for all the Raceview Kindergarten and Child Care's
Legal Fees

6. Permission for Evacuations

I / We hereby give permission for our child to participate in regular evacuation drills. I / We understand that our child will be relocated from the Centre under the supervision of their caregivers and centre staff to a safety zone for evacuation purposes. (Please refer to the Centres Evacuation Plans and Procedures for information.)

7. Sunscreen Application

I / We agree for the Centre Staff to apply sunscreen regularly to our child for outdoor play purposes. I / We understand that the Centre may use a variety of sunscreen brands from time to time, and this information will be advised to us on Parent Communication Boards in the Centre foyer and rooms. If my child requires special sunscreen I/we agree to supply this product to the centre.

8. Insect Repellent Applications

I / We agree for Centre Staff to apply Insect Repellent to our child where necessary for indoor or outdoor purposes. I / We understand that the Centre may use a variety of insect repellent brands from time to time, and this information will be advised to us on Parent Communication Boards in the Centre foyer and rooms. If my child requires special repellent I/we agree to supply this product to the centre.

9. Child Care Subsidy (Lump Sum Claims)

I / We understand that it is our responsibility to notify the Centre of our Customer Reference Numbers (CRNs) even where our family will not be claiming Child Care Subsidy as reduced fees on a weekly basis.

10. Parent Handbook

I / We acknowledge that we have received, been shown where to find or have read the Centre’s Parent Handbook. I / We understand any changes to this Handbook will be displayed on the Parent Communication Boards in the Centre foyer and rooms.

11. Centre Policies

I / We acknowledge that the Centre Policies are available in the Centre’s foyer at all times to view. I / We understand that any changes to these policies will be carried out where appropriate in consultation with us as Parents / Guardians and any changes to these policies will be displayed on the Parent Communication Boards in the Centre foyer.

12. Cancellation of Care

I / We understand that two week’s written notification is required in advance when cancelling care. I/We also understand that our child/ren must attend the last day of care stated in the two weeks’ notice.

13. Fees for Public Holidays

I / We understand that Public Holidays are charged at the normal daily fee rate with a $15 discount (on 12 hour sessions only) and that complimentary make-up days will not be available.

14. Late Fees

I / We understand that late fees will be charged if our child is not collected by the advertised closing time, and that no Child Care Subsidy can be claimed for this fee. Late fees charged are as follows: $1 per minute for each minute that your child has not been collected after closing time (minimum late fee: $15.00).

15. Priority of Access

I / We understand that if our family falls under Priority Access we may be required to alter our days or give up our place in the Centre in order to provide a place for a higher Priority family according to the following Priority Access Guidelines and our Centre Policy: First Priority – children at risk or serious abuse or neglect; Second Priority – children whose parents satisfy the work, training and study guidelines specified by the Government ; and Third Priority – all other children.

16. Infectious Diseases / Clearance Certificates

I / We understand that our child will be excluded from the Centre if they contract a contagious disease or condition. I / We understand that our child will not be accepted back into the centre until a ‘clearance certificate’ is issued from a Medical Practitioner. Please refer to our Centre Policies for further information.

17. Non - Immunisation

I / We understand that if our child is NOT immunised in accordance to the Government requirements (refer to our immunisation details page) our child will be excluded from the centre until the infectious period of the disease or condition has passed. (Please refer to our Centre Policies for further information).

18. Presence of Visitors and Volunteers

I / We understand that occasionally the Centre may have visitors and/or volunteers assisting in the Centre. I / We consent to our child being in the presence of visitors and/or volunteers under the Centre Staff supervision.

19. Confidentiality of Enrolment Records

I/We understand that information in the child’s enrolment record is not divulged to another person unless necessary for the care or education of the child, to manage medical treatment of the child, where expressly authorised by the parent or prescribed in the Children’ Services.

20. Enrolment Fees & BOND
I/We understand that I must pay an annual Enrolment fee of $33.00, this fee subsidises the centre's administration, internet, paper and resource costs. I/We also understand that I must pay a BOND of $100.00 prior to enrolment. This Bond will be refunded on conclusion of my child's enrolment four weeks after my child's last attended day, as long as there is no debt against my account.

21. Social Media – Please read
I/We give permission to Plainlands Kindergarten and Childcare and their Educators to take and use any photographs or videos of my child either in full or in part, in conjunction with any wording or artworks for the following purposes. As a way of seeing your children progress - we use "story park" and upon enrolment an invitation will be sent to you via email. (please tick all that apply):

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LIKE US ON FACEBOOK www.facebook.com/Plkcc Or Search Plainlands Kindergarten & Child care in the search bar in the Facebook App

FOLLOW US ON INSTAGRAM @kindychildcareaus

Or Visit our Website: www.plkcc.com.au

OFFICE USE ONLY -  (BELOW IS OFFICE USE ONLY - NO NEED FOR YOU TO FILL OUT ----------------------------------------------------------------
Enrolment Details entered
Child health/immunisation record sighted and filed
IDebit Pro
Enrolment and/or BOND Paid
BOND has been transferred

For School Aged child/ren travelling via bus:

Transportation Form Signed
Risk Assessment completed
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