Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Additional Emergency Contacts (also able to pick up child):
Custodial Statement. Are there any custodial arrangements concerning your child? Yes □ No □ If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Please note: if you are naming the Father or Mother of the child we cannot prevent them from collecting or visiting unless we have a custody order on file. Name: Name: Relationship to the child: Relationship to the child: Enrolment Details: Date of Enrolment: Date of Entry: Date of Exit: Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total number of hours: Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours 20 Hours ECE at this service Total number of hours: 20 Hours ECE at another service Total number of hours: Parent/Guardian Signature: Date: / / 20 Hours ECE Attestation: Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick One Yes No Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the above, please sign to confirm that:
Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Child’s doctor: Name: Phone: Name of medical centre: Health Illness/allergies: Is your child up-to-date with immunisations? Tick One Yes No (Please provide verification of all immunisations) For staff: Immunisation records sighted and details recorded: Tick One Yes No Medicine
Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: :❑ Yes :❑ No Name: Name: Name: Name: ♦ Enrolment Details: Date of Enrolment: / / Date of entry: / / Date of Exit: / / Days Enrolled: Monday Tuesday Wednesday Thursday Friday TIMES ENROLLED Mornings – 2 year olds only Limited spaces apply 8:15am-1pm Total number of hours
Custodial Statement. Are there any custodial arrangements concerning your child? Yes □ No □ If yes, please supply a copy of the court order/legal documents for our records Child Medical Information: Doctors Name: Medical Facility: Address: Phone: Allergy or medical conditions: Immunisation certificate supplied: Yes □ (please ensure a copy of your child’s immunisation certificate is attached) Enrolment Terms and Conditions ST MARYS PRESCHOOL I wish to enrol my child at the St Marys Preschool and agree to the following conditions: Children’s needs I agree that I will provide all necessary extra items that my child requires while at the St Marys Preschool (i.e lunch, drink, nappies, medication when required, sun hat and extra clothing for messy play) Regulations I am aware that there is a copy of the Preschool Charter available to read on request I am aware that all Preschool policies and procedures are available on request I am aware that I am required to sign my child in and out on the attendance register, daily I am aware that I am required to sign my child’s monthly attendance records once a month I have read and agreed to the Preschool policy on sleep monitoring Health and Safety I will keep my child home when he/she is sick or has infectious illnesses I give consent for Preschool staff to administer medication from a registered practitioner that is supplied by myself, and must be recorded in the medical register, and verbally explained to the head teacher or preschool staff In the case of an emergency, I authorise the Preschool to obtain medical assistance and that my child may be transported, by car, for urgent medical attention and understand that all cost will be met by myself I authorise staff to apply sunscreen supplied by the Preschool or my child’s own when needed I agree to pick my child up from the Preschool if my child becomes unwell during the day within one hour of being notified Enrolment I confirm that my child is not enrolled at any other childcare centres / preschools Fees I agree to pay the Preschool’s fee policy and have read and signed the attendance and fee agreement Trips and Excursions I agree for my child to be taken on walks outside and within walking distance from the Preschool I understand that I will be advised of any trips requiring transport and that I will be required to complete a permission form before my child is taken on these; and will be taken under the Preschool’s excursion policy Observations With regards...
Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Health & Wellbeing: Does your child have any medical conditions, illnesses, food allergies, dislikes, fears, special needs that Rosy Cheeks staff should be aware of? Tick One Yes No If YES, please provide details: Is your child up-to-date with immunisations? Tick One Yes No (Please provide verification of all immunisations) For staff: Immunisation records sighted and details recorded: Tick One Yes No Child’s Doctor: Name: Phone: Name of medical centre: Medicine:
Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Child’s doctor: Name: Phone: Name of medical centre: Any changes to this form must be signed and dated by the parent/guardian. Health Illness/allergies: Is your child up-to-date with immunisations? Copy to be provided. Tick One Yes No For staff: Immunisation records sighted and details recorded: Tick One Yes No Medicine
Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Health Illness/allergies: Is your child up-to-date with immunisations? Tick One Yes No (Please provide verification of all immunisations) To what age? For staff: Immunisation records sighted and details recorded: Tick One Yes No In the event of an accident or emergency involving my child, I/we authorize the Centre to seek such advice or treatment as it deems necessary in the best interests of my/our child, while making all efforts to contact a parent/guardian Yes No Medicine
Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: ♦ Enrolment Details: Date of Enrolment: / / Date of entry: / / Date of Exit: / / Days Enrolled: Monday Tuesday Wednesday Thursday Friday 8:30am–3:00pm Total number of hours: Transition to School Sessions For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 hours ECE funding. Please note that Poppies Kindergarten does not provide sessions of six hours or less per day.
Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Doctor: Name: Phone: Address: Medical Centre: Health Illness/allergies (please specify) Is your child up-to-date with immunisations? Circle one Yes No (Please provide verification of all immunisations) If No, will you be immunising your child in the future? For staff: Immunisation records sighted and details recorded: Circle one Yes No Individual needs: Disabilities / health problems (please specify) (Information may be made available to Public Health when required)
