Enrol Online Step 1 of 11 9% Dear Parent/Guardian, Welcome to Immanuel Early Learning Centre To assist us in providing the best possible care for you and your child, please complete the following form fully and accurately. We understand that paperwork can be time consuming. However, this information will help us to provide individualised care that meets the specific needs of your child. Please ensure you have read the documentation carefully prior to signing the enrolment agreement. This agreement is a binding contract and outlines your commitment with regards to: Providing current and accurate information about your child Notifying our Service of any changes that may impact on your child's needs or our provision of care Ensuring your contact details remain current at all times Payment of fees We ask that you pay particular attention to each section that requires a signature as enrolment cannot proceed until all sections are signed. Do not hesitate to ask for assistance when completing the enrolment form. We are more than happy to help. Your enrolment package consists of the following documents that must be completed, submitted and returned: Enrolment form Acceptance of ELC Place Offer form (to be completed at IELC) Bond Payment form (to be completed at IELC) Parent Code of Conduct (to be completed at IELC) The following documentation must be provided to the Service with your completed enrolment form: Health Record including Immunisation History Status Birth Certificate Medical Action Plan for (Anaphylaxis, Asthma or General Health Management Plan) Documents relating to additional needs or diagnosed disability (medical records, specialist support services referral) Documents relating to any Parenting Order/Plan, Domestic Violence Orders or other legal documents relating to the child Please ensure that all sections are signed and initialed.Information About Your ChildFull NameOther name(s) your child is known byDate of Birth DD MM YYYY Age at enrolmentGenderMaleFemaleCountry of birthHome address Street Address Address Line 2 City State / Province / Region Postcode Cultural backgroundIdentify as AboriginalIdentify as Torres Strait IslanderOtherLanguage(s) used at homeReligionMedicare NumberMedicare Number ExpiresMedical PracticeName of Medical PractitionerMedical Practice Contact numberMedical Practice AddressFAO Customer Reference Number (CRN)Does your child have a Health Care CardYes (please supply a copy)NoDoes your child have any siblings that attend an Approved Early Childhood CentreYes (please list details below)NoService (i.e. OSHC, FDC or Kindergarten)Number of siblings in care: Care Arrangements and Legal OrdersIn order to comply with Section 160 (4) of the Education and Care Services National Regulations the Service must be provided with copies of any Court appointed documents relating to the child, this may include but is not limited to: Parenting Order means a parenting order within the meaning of section 64B(l) of the Family Law Act 1975 of the Commonwealth; Parenting plan means a parenting plan within the meaning of section 63C(1) of the Family Law Act 1975 of the Commonwealth, and includes a registered parenting plan within the meaning of section 63C(6) of that Act. Legal/Court Appointed Documents Should your child be named in any legal document, such as a Restraining Order that legally denies a person/persons access to the child, a copy of these documents will need to be provided to the Service. Is there a Parenting Order or Parenting Plan in place that relates to your child?YesNoIs there a Protection Order in place in which your child is named?YesNoIs there anyone legally denied access to the child?YesNo Information About Your Child's Health and WellbeingA general health plan must be used to manage conditions that require ongoing monitoring or pose a particular risk such as epilepsy or children prone to febrile convulsions. All Health Management Plans must be signed by a medical practitioner and a copy provided to the Service upon enrolment. After completing the checklist below please provide details of all medical conditions, dietary restrictions and all conditions that require a management plan. Is your child at risk of AnaphylaxisYesNoDoes your child have an Anaphylaxis Plan in placeYesNoDoes your child have AsthmaYesNoDoes your child have an Asthma Plan in placeYesNoDoes your child take medication regularlyYesNoDoes your child have a medical condition that may impact on their time in careYesNoDoes your child have a General Health Plan in placeYesNoIs your child's immunisation up to dateYesNoDo you have a medical exemption for immunisationYesNoDoes your child have any dietary restrictionsYesNoIs your child accessing any specialist support services or Allied Health professionalYesNoDoes your child present with any additional needs or have a diagnosed disabilityYesNoDoes your child require any support with interpersonal relationshipsYesNoDoes your child require any support with self-care skillsYesNoDoes your child require any support with mobilityYesNoDoes your child require any support communicatingYesNoDoes your child require any learning supportYesNoDoes your child have any additional support needs not mentioned aboveYesNoPlease provide details of all medical conditions including treatment and medications. If your child takes medication on a regular basis you will be required to complete a Long Term Medication form (WHS.009b)Please provide details of all dietary restrictionsPlease provide details of any specialist support services, such as Paediatrician, Occupational Therapy, Speech Pathology or other Allied Health professional your child seesPlease provide details of any disability your child has been diagnosed with or is currently being assessed forPlease provide details of any additional needs your child may have in terms of communication, interpersonal relationships and additional learning support they may need Cultural Connections and Family TraditionsPlease tell us about your family: Are there any religious or cultural practices that your family observes? Are there any family traditions or celebrations that are significant to your child? What are your expectations for your child's time at our ServiceProviding quality care and educational environments for your child is our goal. How can we best support your child whilst in our care? Family ParticipationPlease indicate areas family members may be able to offer assistance or wish to participate in. For example, you may like to become involved in the Advisory Group, comprised of members from the parent group, College/school (where a Service is co-located on a school site), congregation and local community. Alternatively, you may have a particular skill you can share with the children or find time to help with maintenance. Parent/Guardian Information - 1st Parent/Guardian1st Parent/Guardian Full Name(Parent/Guardian who will be claiming CCS) Relationship to childDate of Birth DD MM YYYY Do you reside with the childYesNoIf 'No' please enter your address below Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneWork PhoneMobile PhoneEmail AddressCultural backgroundIdentify as AboriginalIdentify as Torres Strait IslanderLanguage(s) spoken at homeReligionWorkplace and OccupationFAQ Customer Reference Number (CRN)Parent/Guardian Information - 2nd Parent/Guardian2nd Parent/Guardian Full Name(Parent/Guardian who will be claiming CCS) Relationship to childDate of Birth DD MM YYYY Do you reside with the childYesNoIf 'No' please enter your address below Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneWork PhoneMobile PhoneEmail AddressCultural backgroundIdentify as AboriginalIdentify as Torres Strait IslanderLanguage(s) spoken at homeReligionWorkplace and OccupationFAQ Customer Reference Number (CRN) Emergency Contacts and Authorised NomineesIn accordance with 170(5) of the Education and Care Services National Law and sections 160, 161, 102 & 99 of the Regulations, a Parent/Guardian is required to nominate Emergency Contacts and Authorised Nominees authorised to carry out the following responsibilities for their child. Emergency Contact: a person who is to be notified of an emergency involving the child if any parent of the child cannot be immediately contacted; Authorised nominee [collection]: a person who has been given permission by a parent or family member to collect the child from the education and care service Authorised nominee [medical]: a person who is authorised to consent to medical treatment of, or to authorise administration of medication to, the child Authorised nominee [excursion]: a person who is authorised to authorise an educator to take the child outside the education and care service premises Emergency Contact/ Authorised Nominee 1.Full NameRelationship to childContact NumberStreet# and nameSuburb and postcodeEmergency ContactYesNoEmergency ContactYesNoAuthorised Nominee [collection]YesNoAuthorised Nominee [medical]YesNoAuthorised Nominee [excursion]YesNoNominee Signature:Emergency Contact/Authorised Nominee 2.Full NameRelationship to childContact NumberStreet# and nameSuburb and postcodeAuthorised Nominee [collection]YesNoAuthorised Nominee [medical]YesNoAuthorised Nominee [excursion]YesNoNominee Signature:Emergency Contact/Authorised Nominee 3.Full NameRelationship to childContact NumberStreet# and nameSuburb and postcodeAuthorised Nominee [collection]YesNoAuthorised Nominee [medical]YesNoAuthorised Nominee [excursion]YesNoNominee Signature:Emergency Contact/Authorised Nominee 4.Full NameRelationship to childContact NumberStreet# and nameSuburb and postcodeAuthorised Nominee [collection]YesNoAuthorised Nominee [medical]YesNoAuthorised Nominee [excursion]YesNoNominee Signature: PermissionsMedical Consent I/We authorise the nominated supervisor, educator or approved provider to provide any required first aid and to facilitate medical attention in the event of an emergency. I/We give permission for staff to obtain any medical, hospital and ambulance service in the case of an accident or emergency involving my/our child and accept responsibility for payment of all expenses associated with such treatment. I/We understand that every effort will be made to contact me/us in the event of any illness or accident (Reg. 161).1st Parent/Guardian Initial2nd Parent/Guardian InitialPermission to photograph and record video footage of child. (compulsory; if no permissions granted please tick 'none of the below') I hereby authorise representatives of the Approved Provider (such as the Nominated Supervisor or an Educator) to photograph and record video footage of my child and display their picture within the centre. In addition to this I also permit the specific uses indicated below. I understand that the Service where authorised will use images at their discretion.None of the of the options below; permission is limited to displays within the serviceYesNoPhotographs can be used in the Service newsletterYesNoPhotographs can be used in newsletters (distributed to staff and families in Lutheran communities)YesNoPhotographs can be used for advertising purposes within newspapers, for trade displays or local libraryYesNoPhotographs and video can be displayed on the Service Facebook page, which may be accessible by the general publicYesNo1st Parent/Guardian Initial2nd Parent/Guardian InitialPermission to share information The Service is co-located on the Immanuel Lutheran College Campus, a request may be made for family contact details (postal or email) for the purpose of sharing school promotional and/or enrolment informationI give permission for my information to be shared with Immanuel Lutheran CollegeYesNo1st Parent/Guardian Initial2nd Parent/Guardian InitialPermission to apply Sunscreen Prior to outdoor play children are required to have Sunscreen. Sunscreen is supplied by the Service and details of the product(s) used will be displayed at the Service on a WHS.027 Sunscreen Display Poster for your information. Should your child have allergies that prevent the use of sunscreen product or the particular brand, you may supply a suitable alternative and complete a Long Term Medication form (WHS.009b)I give permission for my child to apply/have Insect Repellent applied for them as, supplied by the ServiceYesNoI give permission for my child to apply/have Sunscreen applied for them, as supplied by the ServiceYesNo1st Parent/Guardian Initial2nd Parent/Guardian Initial Enrolment AgreementIn consideration of enrolling my child at the Service I the undersigned do hereby agree that: I understand that in the case of sudden illness or accident, the Service Leader shall have discretionary power to take all reasonable steps to provide appropriate medical attention for my child; that the parents/guardians will be contacted as soon as possible; and that any costs incurred will be borne by the parents/guardians. I agree to keep my child at home when suffering from a heavy cold or other infectious illness likely to affect the health of the other children or staff. I agree to notify the Service promptly of the reasons for any absences. I will ensure that the child is brought to the Service by a responsible person and taken to an Educator prior to the responsible person leaving the service (over the age of 18). I will ensure that the child is collected by an Authorised Nominee (identified on page 6 under Emergency Contacts and Authorised Nominees) before the official closing time. Should I be late collecting the child I agree to pay the Late Collection Fee (LDC - $30.00) I will make every effort to inform the Service of changes in arrival and departure times and procedures, especially in regard to persons other than those recorded, collecting my/our child. I understand that the Service cannot and will not allow my child to leave the service with a person who is not an Authorised Nominee unless permission is given by me to the Service prior to collection. I understand and authorise that the Service does not release my child for collection to any person who appears to be under the influence of alcohol or drugs at the time of collection or who may, in the reasonable opinion of the Service, pose any other risk to my/ our child. I understand and accept that fees must be paid in advance, that the normal fees will be payable at all times including the absence of my/our child for sickness and holidays. I understand that if fees are not paid, my child's continued enrolment in the Service cannot be guaranteed. I agree to, on termination of my child's enrolment at the Service, give notice as per the Service policy or forfeit two week's fees, in lieu of notice. I am aware that if my child does not attend during the notice period, CCB cannot be claimed and I will be required to pay full fees. I agree to notify the Service immediately of any change in my/our address and/or telephone numbers or any change in the addresses and/or telephone numbers of the Emergency Contacts and Authorised Nominees. I understand that where we have defamed, offended, vilified or insulted the reputation of the Service, its employees, QLECS, the Lutheran Church its employees and officers, in any way on any social media forum or other publication that my child's booking will be terminated immediately and I agree to delete any public comments made immediately on the Services direction. I also acknowledge that the Service may seek legal representation in relation to any comments made by us either during or after my child's attendance at the service in relation to comments made by us in social media or other publication. I have read the Parent Handbook about the Service and agree to co-operate in all things to the best of my ability. I have visited the Service and discussed with the Service Leader the enrolment of my child and understand the importance of family co-operation and agree to participate when possible in the activities of the Service. I agree to be bound by the constitution/ Rules and/or any by-laws of the Service/ Association. 11. I understand that fees are payable in advance each week; all accounts that do not have a zero balance each Monday morning prior to the statement run will incur an Overdue Account Fee ($50). Fees are payable as per the enrolment agreement regardless of whether a statement is issued. I understand that my child is provided with one ELC polo shirt and one ELC hat on initial enrolment and both of these items are a compulsory uniform requirement that my child is required to wear on each day of attendance. Should any of these items be lost or need replacing, I understand that I am required to replace these items at my expense. Debt Recovery acknowledgement statement I the parent/guardian agree that the information provided in this application is true and correct and will be relied upon by the Service. I the parent/guardian agree to notify the centre immediately should there be any change in circumstances from the details as outlined in the enrolment form including living arrangements of the child and/or parent/guardian within 7 days of the date of such a change. I the parent/guardian agree to pay outstanding childcare fees and cancellation fees where applicable together with all debt recovery expenses including fees, court costs, legal fees reasonably incurred by the childcare centre. In the case of a default of payment, I the parent/guardian acknowledge that any enrolment information specifically required for the purpose of debt recovery and identification of individuals in default may be forwarded to the collection agency for legal recovery action. In understand that in the case of a default on payments for childcare fees, enrolment details may be listed on the National Default Registry for a period of six (6) years and thirty days or until paid. This information may be accessed by other care providers at the time of enrolment. I the parent/guardian acknowledge that care may be refused in case of a default. 1st Parent/Guardian signatureDate DD MM YYYY 2nd Parent/Guardian signatureDate DD MM YYYY PermissionsELC Planned Activities/Excursions within the College Grounds and Immanuel Gardens Aged Care I/We authorise my child to participate in the ELC planned activities that will be held within the College Grounds and visits to Immanuel Gardens Aged Care during the year. I have been informed of the areas that my child will visit and that I can view the Risk Management Plans at any time.1st Parent/Guardian Initial2nd Parent/Guardian InitialHead Lice Screening (Compulsory) I/We authorize for my child to participate in a periodic head lice screening process and visual checks as per the policy. I acknowledge that I have received and read the participant information (contained in the Parent Handbook), which explains the aims of the process, and the procedures involved. 1st Parent/Guardian Initial2nd Parent/Guardian InitialSecurity System (Key fobs) Immanuel Early Learning Centre views protecting the safety of the children and staff at our service as fundamental and therefore have a security access system installed (located at the front door). A payment of $20.00 will be required for each fob, this covers the cost to the centre to order key fobs for each family and is refunded when the key fobs are returned. Key Fob Agreement: I agree to use our security fobs to enter the building and will not give our fob to any other than an authorized nominee. I understand that we are required a $20.00 per key fob. I understand that if I/We lose a key fob I/We will be required to pay for the replacement fob. I will inform the centre if a non-key fob holder is collecting the child.1st Parent/Guardian Initial2nd Parent/Guardian Initial