Common use of Custodial Statement Clause in Contracts

Custodial Statement. Do both parents have day-to-day care of your child? YES/NO If “NO” are there any parenting orders or custodial arrangements concerning your child? Please advise the supervisor of any such orders or arrangements. (Please note, a court order needs to be sighted and a copy held on file for us to prohibit a parent or guardian from collecting his/her child.) Name of person who is NOT allowed to collect my child: Name Court Order is on file YES/NO In which programme are you enrolling your child? Holiday programme YES/NO Casual Booking YES/NO (Please note that casual bookings require at least one day’s notice) Permanent booking YES/NO (Indicate days required below) Monday Tuesday Wednesday Thursday Friday Mornings Start Time Afternoons Finish Time The school your child attends Room Number Child’s doctor Surgery Phone In the event of a medical emergency, I understand my child will be taken to hospital in an ambulance if necessary. The parents (in the first instance) or an approved contact person will be notified immediately. All medical costs incurred are at the child’s principal caregiver’s expense. I give permission for the use of Arnica cream to be applied to bumps and bruises. YES/NO I give permission for the staff to apply sunblock to my child’s skin. YES/NO I give permission for my child to be given basic First Aid treatment by the staff. YES/NO If my child has a fever, rash, sticky eyes, diarrhoea or vomiting s/he will be kept at home until the symptoms are gone. If your child shows such symptoms at the programme, GASP staff will notify you and you will arrange to have your child picked up as soon as possible.

Custodial Statement. Do both parents have day-to-day care of your child? YES/NO If “NO” are Are there any parenting orders or custodial arrangements concerning your child? Please advise Yes □ No □ If yes, please supply a copy of the supervisor 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 GEORGES PRESCHOOL I wish to enrol my child at the St Georges 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 Georges Preschool (i.e lunch, drink, nappies, medication when required, sun hat and extra clothing for messy play) Regulations • 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 team leader or centre 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 Duel Enrolment • I declare and 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 such orders or arrangementstrips 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 to the privacy act, I agree / disagree that photos, videos and observations of my child may be taken for the purpose of keeping a portfolio folder for my child and that the use of these by staff and students of the Preschool during training for early childhood education Clothing • I accept that care will be taken by the Preschool in the care of my child’s clothing, and I understand that the Preschool will not be accountable for lost items. (Please note• I will ensure that my child’s clothing is named, and I will check the lost property on a court order needs regular basis Education Review Office, policies and procedures • Copies of these are displayed in the Preschool. I agree to take the time to read through these important documents Collection of my child • I understand the Preschool’s opening and closing hours. I agree to phone the Preschool if I am going to be sighted late, and a copy held I agree to pay any late fees that may be charged The Privacy Act • The information is needed in this form, by the Preschool, to comply with statutory requirements to enable staff to contact you to ensure care and education of your child. We require these records to be kept for seven years I undertake to adhere to the requirements of these terms and conditions and I also take responsibility for the payment of fees on file for us time. I undertake that failure to prohibit a parent or guardian from collecting his/her child.) Name comply with these requirements of person who is NOT allowed the Preschool could lead to collect my child’s exclusion from the Preschool Signed parent/guardian:……………………………………………………………………………. Date:……………………………………….…….. Name:………………………………………………………………………………………………… Signed staff member:………………………………………………………………………………. Date:………………………………..…………….. Name:………………………………………………………………………………………………… Fee and Attendance Agreement ST GEORGES PRESCHOOL Child’s full name:…………………………………………………………………………………………………………………. Start date:………………………………………………….. Est. end date:……………………………………………….… Please indicate the drop off and pick up times: Name Court Order is on file YES/NO In which programme are you enrolling your child? Holiday programme YES/NO Casual Booking YES/NO (Please note that casual bookings require at least one day’s notice) Permanent booking YES/NO (Indicate days required below) Days Enrolled: Monday Tuesday Wednesday Thursday Friday Mornings Start Time Afternoons Finish Time The school your child attends Room Number Child’s doctor Surgery Phone In Times Enrolled: Total number of hours: For 20 Hours ECE fill out boxes below with the event hours attested e.g. 6 hours 20 Hours ECE at this service 20 Hours ECE at another service Total number of a medical emergency, I understand my child will be taken to hospital in an ambulance if necessary. The parents (in the first instance) or an approved contact person will be notified immediately. All medical costs incurred are at the child’s principal caregiver’s expense. I give permission for the use hours: Total number of Arnica cream to be applied to bumps and bruises. YEShours: Parent/NO I give permission for the staff to apply sunblock to my child’s skin. YES/NO I give permission for my child to be given basic First Aid treatment by the staff. YES/NO If my child has a fever, rash, sticky eyes, diarrhoea or vomiting s/he will be kept at home until the symptoms are gone. If your child shows such symptoms at the programme, GASP staff will notify you and you will arrange to have your child picked up as soon as possible.Guardian Signature: _ Date: _ / _ / _ 20 Hours ECE Attestation:

Custodial Statement. Do both parents have day-to-day care of your child? YES/NO If “NO” are there any parenting orders or custodial arrangements concerning your child? Please advise the supervisor of any such orders or arrangements. (Please note, a court order needs to be sighted and a copy held on file for us GASP to prohibit a parent or guardian from collecting his/her child.) Name of person who is NOT allowed to collect my child: Name Court Order is on file YES/NO In which programme are you enrolling your child? Morning YES/NO Afternoon YES/NO Holiday programme YES/NO Casual Booking YES/NO (Please note that casual bookings require at least one day’s notice) Permanent school term booking YES/NO (Indicate days required below) Monday Tuesday Wednesday Thursday Friday Mornings Start Time Afternoons Finish Time The school your child attends Room Number Child’s doctor Surgery Phone In the event of a medical emergency, I understand my child will be taken to hospital in an ambulance if necessary. The parents (in the first instance) or an approved contact person will be notified immediately. All medical costs incurred are at the child’s principal caregiver’s expense. I give permission for the use of Arnica cream to be applied to bumps and bruises. YES/NO I give permission for the staff to apply sunblock to my child’s skin. YES/NO I give permission for my child to be given basic First Aid treatment by the staff. YES/NO If my child has a fever, rash, sticky eyes, diarrhoea or vomiting s/he will be kept at home until the symptoms are gone. If your child shows such symptoms at the programme, GASP staff will notify you and you will arrange to have your child picked up as soon as possible.

Custodial Statement. Do both parents have day-to-day care of your child? YES/NO If “NO” are Are there any parenting orders or custodial arrangements concerning your child? Please advise Yes □ No □ If yes, please supply a copy of the supervisor 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 such orders or arrangementstrips 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 to the privacy act, I agree / disagree that photos, videos and observations of my child may be taken for the purpose of keeping a portfolio folder for my child and that the use of these by staff and students of the Preschool during training for early childhood education Clothing  I accept that care will be taken by the Preschool in the care of my child’s clothing, and I understand that the Preschool will not be accountable for lost items. (Please note I will ensure that my child’s clothing is named, and I will check the lost property on a court order needs regular basis Charter, Education Review Office, and policies  Copies of these are displayed in the Preschool. I agree to take the time to read through these important documents Collection of my child  I understand the Preschool’s opening and closing hours. I agree to phone the Preschool if I am going to be sighted late, and a copy held I agree to pay any late fees that may be charged The Privacy Act  The information is needed in this form, by the Preschool, to comply with statutory requirements to enable staff to contact you to ensure care and education of your child. We require these records to be kept for seven years I undertake to adhere to the requirements of these terms and conditions and I also take responsibility for the payment of fees on file for us time. I undertake that failure to prohibit a parent or guardian from collecting his/her child.) Name comply with these requirements of person who is NOT allowed the Preschool could lead to collect my child’s exclusion from the Preschool Signed parent/guardian:……………………………………………………………………………. Date:……………………………………….…….. Name:………………………………………………………………………………………………… Signed staff member:………………………………………………………………………………. Date:………………………………..…………….. Name:………………………………………………………………………………………………… Fee and Attendance Agreement ST MARYS PRESCHOOL Child’s full name:…………………………………………………………………………………………………………………. Start date:………………………………………………….. Est. end date:……………………………………………….… Please indicate the drop off and pick up times: Name Court Order is on file YES/NO In which programme are you enrolling your child? Holiday programme YES/NO Casual Booking YES/NO (Please note that casual bookings require at least one day’s notice) Permanent booking YES/NO (Indicate days required below) Days Enrolled: Monday Tuesday Wednesday Thursday Friday Mornings Start Time Afternoons Finish Time The school your child attends Room Number Child’s doctor Surgery Phone In Times Enrolled: Total number of hours: For 20 Hours ECE fill out boxes below with the event hours attested e.g. 6 hours 20 Hours ECE at this service 20 Hours ECE at another service Total number of a medical emergency, I understand my child will be taken to hospital in an ambulance if necessary. The parents (in the first instance) or an approved contact person will be notified immediately. All medical costs incurred are at the child’s principal caregiver’s expense. I give permission for the use hours: Total number of Arnica cream to be applied to bumps and bruises. YEShours: Parent/NO I give permission for the staff to apply sunblock to my child’s skin. YES/NO I give permission for my child to be given basic First Aid treatment by the staff. YES/NO If my child has a fever, rash, sticky eyes, diarrhoea or vomiting s/he will be kept at home until the symptoms are gone. If your child shows such symptoms at the programme, GASP staff will notify you and you will arrange to have your child picked up as soon as possible.Guardian Signature: _ Date: _ / _ / _ 20 Hours ECE Attestation: