Common use of Medicines Clause in Contracts

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Service: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first first aid’ treatment of minor injuries and provided by the service and kept in the first first aid cabinet. Note: The service must provide specific specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific specific category (i) medicines that can be used on my child, provided by the Service: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) child ª ª ª ª Parent/Guardian Signature: _ Date: / _ / _ Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific specific period of time to treat a specific specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: Date: / / t Enrolment Details: Date of Enrolment: / / Date of Entry: / / Date of Exit: / / 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the Category (ii) Medication Register will be completed on a daily basis. hours attested e.g. 6 hours 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Service: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example, for an ongoing condition such as asthma, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare Balclutha. Enrolment Details Date of Enrolment: / / Date of Entry: / / Date of Exit: / / 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. CITY IMPACT CHURCH ECE CENTRES ARE NOT OPEN ON NZ STATUTORY/PUBLIC HOLIDAYS The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / / Session Times Monday Tuesday Wednesday Thursday Friday 8am – 12pm 1pm – 5pm

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service Centre and kept in the first aid cabinet. Note: The service Centre must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the ServiceCentre: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: _ Date: / _ / _ Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the serviceCentre. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: _ Date: / _ / _ Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _ ♦ Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ _ /_ / Date of Exit: / _ / _ How did you hear about us: Please select centre: Tick One Central Queenstown Remarkables Park 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the Category (ii) Medication Register will be completed on a daily basis. hours attested e.g. 6 hours 20 Hours ECE at this Centre Total hours: 20 Hours ECE at another Centre Total hours: Parent/Guardian Signature: Date: / /_ / _ ♦ 20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. This includes, approved sunblock, insect repellent and saline. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to (please cross out any medicines that are you do not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Registerconsent to) ▪ • Sunblock • Antiseptic Cream • Insect Repellent • Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Treatment • Arnica Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) • Saline Solution Parent/Guardian Signature: Date: Signature Date / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine medication is to be given. Parent/Guardian Signature Date / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual plan, for example for an ongoing condition such as asthma, eczema, or diabetes, etc and is for the use of that child only. If your child should require the administering of a requires category (iiiii) medication, the Category (ii) medicines you are required to complete a ‘Medication Register will Category iii’ form which forms part of an individual plan for your child. Complete Asthma Details and Action Plan Form if your child has Asthma Yes No Complete Additional Needs Information Form if your child has eczema, diabetes, etc Yes No Complete Medication Register Category iii Form if your child requires category 3 medicines Yes No For staff: Individual health plan sighted and a copy taken Name of medicine: Method and dose of medicine: When does the medicine need to be completed on a daily basis. taken: (state time or specific symptoms) Yes No Parent/Guardian SignatureSignature Date / / Enrolment Details Xxxxx’s first name Surname / family name Date of enrolment / / Date of entry / / Date of exit / / (forms received) (join date) (leave date) Please note: Date: 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. Days Enrolled Monday Tuesday Wednesday Thursday Friday Total Hours Times Enrolled eg 9:00am – 5:30pm For 20 Hours ECE fill out boxes below with hours attested eg. 6 hours Total Hours 20 hours ECE at this service 20 hours ECE at another service Parent/Guardian Signature Date / / Change of Days / Times of Enrolment Effective date of change / / Days Enrolled Monday Tuesday Wednesday Thursday Friday Total Hours Times Enrolled eg 9:00am – 5:30pm For 20 Hours ECE fill out boxes below with hours attested eg. 6 hours Total Hours 20 hours ECE at this service 20 hours ECE at another service Parent/Guardian Signature Date / / 20 Hours ECE Attestation

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Service: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example, for an ongoing condition such as asthma, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare North Shore. Enrolment Details Date of Enrolment: / / Date of Entry: / / Date of Exit: / / 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. CITY IMPACT CHURCH ECE CENTRES ARE NOT OPEN ON NZ STATUTORY/PUBLIC HOLIDAYS The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / / Session Times Monday Tuesday Wednesday Thursday Friday

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Service: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example, for an ongoing condition such as asthma, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North Shore. Enrolment Details Date of Enrolment: / / Date of Entry: / / Date of Exit: / / 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. CITY IMPACT CHURCH ECE CENTRES ARE NOT OPEN ON NZ STATUTORY/PUBLIC HOLIDAYS The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / / Session Times Monday Tuesday Wednesday Thursday Friday 8am – 12pm 1pm – 5pm

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Service: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example, for an ongoing condition such as asthma, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare Queenstown. Enrolment Details Date of Enrolment: / / Date of Entry: / / Date of Exit: / / 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. CITY IMPACT CHURCH ECE CENTRES ARE NOT OPEN ON NZ STATUTORY/PUBLIC HOLIDAYS The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / / Session Times Monday Tuesday Wednesday Thursday Friday

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪  Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (topically for small bumps and bruises)  Yes  No  Petroleum Jelly / Vaseline (Used for emergency nappy rash and sticky noses)  Yes  No  Insect repellent (to prevent insect bites)  Yes  No  Vicks Vapo Rub (applied to body to help with blocked noses)  Yes  No  Sunscreen (used for sunburn protection (Please supply your own if usedyour child has sensitive skin)  Yes  No  Any medications you may want us to use regularly that you have supplied add here please  Swedish Bitters cream, the treatment will be noted in the Nappy for itchy bites and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) hives  Yes  No  Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One One: Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) • • Parent/Guardian Signature: Date: / / Category (ii) Medicines Medicines: Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori Mãori (Māori Mãori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: Date: / / Category (iii) Medicines: To be filled in if your child should requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only. For staff: Individual health plan sighted and a copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (State time or specific symptoms): Parent/Guardian Signature: Date: / / Health: Illness/allergies: Is your child up-to-date with immunisations? Tick One: Yes No (please provide verification of all immunisations) Enrolment Details: Date of enrolment: / / 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. BUDS AND BLOOMS CHILDCARE IS NOT OPEN ON NZ STATUTORY/PUBLIC HOLIDAYS ALL DAY Minimum of 2 sessions per week Requested Start Date: / / Days Enrolled: Monday Tuesday Wednesday Thursday Friday 8:30am – 12:30pm 1pm – 5pm 8:30am – 3:30pm Full Day (7am – 6pm) For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours Monday Tuesday Wednesday Thursday Friday Total Hours 20 Hours ECE at this service (OFFICE TO COMPLETE) 20 Hours ECE at another service Parent/Guardian Signature: 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 Date: / / If yes to either or both of the above, please sign to confirm that: Your child does not receive more than 20 hours of 20 Hours ECE per week across allservices. You authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Agreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibility for 20 Hours ECE. You consent to the early childhood education service providing relevant information to the Ministry of Education, and to other early childhood education services your child is enrolled at, about the information contained in this box. Parent/Guardian Signature: Dual Enrolment Declaration: Date: / / I hereby declare that my child is/is not enrolled at another early childhood institution at the same times that he/she is enrolled at Buds and Blooms Childcare Parent/Guardian Signature: Date: / / Required Information for Licensing Purposes: Excursions: I give permission for my child to take part in regular excursions within the local area, having read and agreed with the excursions procedures outlined in the Excursions Policy. Tick One: Yes No Photo/Video/Multimedia: I give permission for my child to be photographed for the purposes of assessment, planning and evaluation inclusive of individual and group learning stories and centre-wide planning displays. Tick One: Yes No I give permission for my child to be photographed and filmed for the purposes of Buds and Blooms multimedia production inclusive of public forums such as Buds and Blooms website/FB Page/Instagram/newsletters. Tick One: Yes No Conditions of Enrolment: Buds and Blooms Childcare has a unique Christian Philosophy. Buds and Blooms Childcare has a number of policies that set out the procedures that are in place for the care and education of the children who attend. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service and understand how you can have input to policy review. You accept responsibility for the payment of all fees. Where fees remain unpaid and no arrangement has been made between you and the Centre as to the payments you agree to abide by the Centre’s financial policy which is available in our enrolment pack. You acknowledge that you will inform Xxxx and Blooms Childcare four weeks in advance if you wish to withdraw your child. Failure to do so will require you to pay four weeks fees for each child in lieu. Parent Declaration: I declare that all the administering above information is true and correct to the best of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basismy knowledge. Parent/Guardian Signature: Date: / // Service Declaration: On behalf of Xxxx and Blooms Childcare, I declare that this form has been checked and all relevant sections have been completed. Service signature: Date: / / 1

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: _ Date: / /_ / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: _ Date: /_ / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only. For staff: Individual health plan sighted and a copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (State time or specific symptoms) Parent/Guardian Signature: _ Date: /_ / Enrolment Details: Date of Enrolment: / _ / _ Date of Entry: /_ / _ Date of Exit: / _ / 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: _ Date: /_ / 20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) Cream ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) Cream ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Castor cream Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: Date: / _ / Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medication, the Category (ii) Medication Register will be completed on a daily basisPlease also fill in an ongoing medicine approval form. Parent/Guardian Signature: Date: / / ⧫ Enrolment Details: Date of Enrolment: / / Date of Entry: / / Date of Exit: / / 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service Centre and kept in the first aid cabinet. Note: The service Centre must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the ServiceCentre: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart)     Parent/Guardian Signature: _ Date: / _ / _ Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the serviceCentre. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: _ Date: / _ / _ Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _  Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ _ /_ / Date of Exit: / _ / _ How did you hear about us: Please select centre: Tick One Central Queenstown Remarkables Park 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the Category (ii) Medication Register will be completed on a daily basis. hours attested e.g. 6 hours 20 Hours ECE at this Centre Total hours: 20 Hours ECE at another Centre Total hours: Parent/Guardian Signature: Date: / /_ / _  20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service Centre and kept in the first aid cabinet. Note: The service Centre must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the ServiceCentre: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart)     Parent/Guardian Signature: _ Date: / _ / _ Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the serviceCentre. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: _ Date: / _ / _ Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _  Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ _ /_ / Date of Exit: / _ / _ How did you hear about us: 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the Category (ii) Medication Register will be completed on a daily basis. hours attested e.g. 6 hours 20 Hours ECE at this Centre Total hours: 20 Hours ECE at another Centre Total hours: Parent/Guardian Signature: Date: / /_ / _  20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s Names of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) cream ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) bite cream ▪ Antiseptic Cream/Liquid (i.e. Savlon, Anti-Flamme Herbal Relief cream ▪ Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) antiseptic liquid Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.drops) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the serviceonly. I acknowledge that written authority as from a parent is to be given at the beginning of each day when a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / Paracetamol liquid or tablets - A small supply is provided by the school, and kept in the first aid cabinet for children should they require it. If any medication is given to your child, they are given written confirmation to take home, advising of symptoms, dose and time given. Do you approve for paracetamol medicine to be given to your child? Tick One Yes No If yes, would you like to be phoned first, before Paracetamol is administered? Y / N Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma, eczema, ADHD etc and is for the use of that child only. Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (State time or specific symptoms) Parent/Guardian Signature: Date: / / ⧫ Enrolment Details: Date you would like your child to start at Ardgowan: / / Office Use Only: Date of Entry: / / Year Level: Room: Date of Exit: / / ⧫ Privacy Statement: We are collecting personal information on this enrolment form for the purposes of providing education for your child. We will use and disclose your child’s information only in accordance with the Privacy Act 1993. Under that Act you have the right to access and request correction of any personal information we hold about you or your child. Details about your child’s identity will be shared with the Ministry of Education. The Ministry of Education shares information about five year olds enrolled in school with Ministry of Health professionals as part of the B4 School Check Ministry of Health initiative.

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Staff: Medication agreement to be completed and signed, for each incident □ Yes □ No Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart)     Parent/Guardian Signature: _ Date: / _ / _ Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: _ Date: / _ / _ Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _  Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ _ /_ / Date of Exit: / _ / _ 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the Category (ii) Medication Register will be completed on a daily basis. hours attested e.g. 6 hours 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / /_ / _  20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) cream ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy Zinc and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) castor oil Parent/Guardian Signature: _ Date: / _ / _ Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori M ori (Māori M ori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: _ Date: / _ / _ Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _ ♦ Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ _ /_ / Date of Exit: / _ / _ 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the Category (ii) Medication Register will be completed on a daily basis. hours attested e.g. 6 hours 20 Hours ECE at this Total hours: service 20 Hours ECE at Total hours: another service Parent/Guardian Signature: Date: / /_ / _ ♦ 20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, and will be used for the as ‘in-house first aid’ treatment of minor injuries and injuries. It is provided by the service and is kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica cream (if used, the treatment will be noted in the Injury/Incident/ RegisterNature’s Kiss) ▪ Insect Bite Cream/Spray Yes No ▪Antihistamine (if used, the treatment will be noted in the Injury/Incident/ RegisterBepanthen) Yes No ▪ Antiseptic Creamliquid (Savlon) Yes No ▪Icepack/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injuryvinegar/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) baking soda Yes No Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific one-off condition or symptom, . It is provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a day. The category (ii) medicine is to will be administeredadministered and documented in the medicines book, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: _ Date: / / Category (iii) Medicines Category (iii) medicines are given to a child regularly, i.e. ongoing and regular administration. The ‘Ongoing Medication Administration Consent Form’ is to be filled in if your child should require requires medication as part of an individual health plan. For example, for an on-going condition such as epilepsy or diabetes etc, and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / Enrolment Details: Date of Enrolment: / / Date of Entry: / / Date of Exit: / / 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / / 20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, but used for the ‘first aid’ treatment and prevention of minor injuries and injuries. It is provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve give permission for category (i) medicines to be used on your child? Tick One Please circle Yes No Name/s of specific If permission is given, the following category (i) medicines that can could be used on my your child, provided by the ServiceCentre: Centre to cross out any medicines that are not used in Centre. ▪ ● NaturoPharm Arnica plus cream or spray ● NaturoPharm Calendula cream ● Dettol Antiseptic ● Sunblock ● Sudocream (if used, the treatment will be noted in the Injury/Incident/ Registerxxxx & xxxxxx oil) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula ● Lavender oil ● Paraderm Plus First Aid Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) ● Corn flour for nappyrash Parent/Guardian Signature: Date: / / Category CATEGORY (ii) Medicines Category MEDICINES: Catergory (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only oronly, or in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults a qualified teacher at the serviceCentre. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will All medicine must have original label attached and must be completed on a daily basisreadable to staff. Parent/Guardian Signature: Date: / / ONGOING ILLNESS - CATEGORY (iii) MEDICINES: To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only. For staff: Individual health plan sighted, and a copy taken: Please circle Yes No Name of Medication: Method and dose of medication: When does the medicine need to be taken? (State specific time or specific symptoms) Parent/Guardian Signature: Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent    P arent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. ParentP arent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only. For staff: Individual health plan sighted and a copy taken: Yes Tick One: No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (State time or specific symptoms) P arent/Guardian Signature: Date: / / Enrolment Details: Date of Enrolment: Date of Entry: / / / / Date of Exit: / / 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours 20 Hours ECE at this service 20 Hours ECE at another service Total hours: Total hours: P arent/Guardian Signature: Date: / / 20 Hours ECE Attestation:

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s Names of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) cream ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) bite cream ▪ Antiseptic Cream/Liquid (i.e. Savlon, Anti-Flamme Herbal Relief cream ▪ Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) antiseptic liquid Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.drops) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the serviceonly. I acknowledge that written authority as from a parent is to be given at the beginning of each day when a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / Paracetamol liquid - A small supply is provided by the service and kept in the first aid cabinet for children should they require it. If any medication is given to your child, they are given written confirmation to take home, advising of symptoms, dose and time given. Do you approve for paracetamol medicine to be given to your child? Tick One Yes No If yes, would you like to be phoned first, before Paracetamol is administered? Y / N Parent/Guardian Signature: Date: / / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma, eczema, ADHD etc and is for the use of that child only. Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (State time or specific symptoms) Parent/Guardian Signature: Date: / / ♦ Enrolment Details: Date of Entry: / / Year Level: Room: Date of Exit: / / ♦ Privacy Statement: We are collecting personal information on this enrolment form for the purposes of providing education for your child. We will use and disclose your child’s information only in accordance with the Privacy Act 1993. Under that Act you have the right to access and request correction of any personal information we hold about you or your child. Details about your child’s identity will be shared with the Ministry of Education. The Ministry of Education shares information about five year olds enrolled in school with Ministry of Health professionals as part of the B4 School Check Ministry of Health initiative. ♦ Parent Declaration

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (topically for small bumps and bruises) 🞏 Yes 🞏 No Pawpaw healing cream for skin irritations 🞏 Yes 🞏 No Insect repellent (to prevent insect bites) 🞏 Yes 🞏 No Supply your own if used, your child has sensitive skin. Name of Insect repellent: ………………………………………………………………. Sudocrem healing skin cream for nappy rash. 🞏 Yes 🞏 No Talcum powder - this will only ever be used to assist us in cleaning sand from the treatment will be noted in the Nappy and Toileting Chartnappy area 🞏 Yes 🞏 No Sunscreen (used for sunburn protection) ▪ Cornflour (🞏 Yes 🞏 No Supply your own if used, the treatment will be noted in the Nappy and Toileting Chart) your child has sensitive skin. Name of sunscreen: ………………………………………………………………. Any medications you may want us to use regularly that you have supplied add here. Name of medication: Instructions: Parent/Guardian Signature: Date: / / Medicine: Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or and specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: Date: / / Category (iii) Medicines - Health / Allergy Plans: N/A Tick ❑ Definition - a prescription (such as asthma inhalers, epilepsy medication etc) or non-prescription (such as antihistamine syrup, lanolin cream etc). To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted, and a copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (State time or specific symptoms) I APPROVE the administration of the category (iiiii) medication, prescription medicines detailed in this form to be used on your child in accordance with the Category (ii) Medication Register will be completed on a daily basisprescription instruction. Parent/Guardian Signature: Date: / / Required Information for Licensing Purposes and Curriculum activities. Photo/video: permission for the child to be photographed for the purposes of assessment, planning and evaluation in accordance with Xxxxxxxx’s privacy policy. ❑ Yes ❑ No

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Serviceservice: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart)     Parent/Guardian Signature: _ Date: / _ / _ Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: _ Date: / _ / _ Category (iii) Medicines To be filled in if your child should require requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _  Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ / / Date of Exit: / _ / _ 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the Category (ii) Medication Register will be completed on a daily basis. hours attested e.g. 6 hours 20 Hours ECE at this Total hours: service 20 Hours ECE at Total hours: another service Parent/Guardian Signature: Date: / /_ / _  20 Hours ECE Attestation: