Young Scholars

Enrolment Form

Child Details

Family name:*	Given name(s):*
Gender:* Male Female	Date of Birth:*
Will you be claiming Child Care Benefit: *	Yes No
Street:*	Suburb:* Postcode:*
Email:*	Phone:*
Cultural Background:	Language used in child's home:
Religion:	Legal Guardian:
Do you have a sibling or have had a child previously enrolled at this centre? If YES, child’s name

Court/Parenting Orders

Is this child named in a Court Order, Parenting Order, or Parenting Plan?

Yes No

Please supply details:

Note: You are required to provide the centre a copy of any Court Order, Parenting Order or Parenting Plan, that directs the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child and the details of the child's residence and contact with parent(s) or other person(s).

Does the Order prohibited any person from having contact with your child?

Yes No

Supply the name of the person/s prohibited from having contact with your child and any additional information you believe would assist our staff:

A copy of the court order is required for the enrolment to be processed. Please deliver a copy to the centre along with a photograph (if possible) of any prohibited person(s).

Is your child of Aboriginal or Torres Strait Islander origin?*	Aboriginal Torres Strait Islander Neither
Does your child have a need for additional assistance in any of the following areas, compared to a child of similar age? *
Learning and applying knowledge, education:	Yes No
Communication:	Yes No
Mobility:	Yes No
Self-Care:	Yes No
Interpersonal interactions and relationships:	Yes No
Other – including general task, domestic life, community and social life:	Yes No
Does your child have a diagnosed disability?:	Yes No
Details:

Priority of Access

Young Scholars Childcare follows the Australian Governments Guidelines for Priority of Access.
This means that priority will be given as follows:

Priority 1 — a child at risk of serious abuse or neglect
Priority 2 — a child of a single parent who satisfies, or of parents who both satisfy, the work, training, study test under section 14 of the A New Tax System (Family Assistance) Act 1999
Priority 3 — any other child.

It is also our duty to inform you that a priority 3 child may be required to make room for a higher priority. If this is the case we will give you at least 14 days’ notice of the need for your child to vacate

CCB and CCR information

Will you be claiming Child Care Benefit: *	Yes No
Child's CRN:	Child's D.O.B:
Parent/Guardian's CRN:	Parent/Guardian's D.O.B:

Note: Fees are billed to Parent/Guardian No.1

Parent/Guardian Information

Please note: If claiming CCB from Centrelink, the child will come under the CRN of parent/guardian 1. All parents/guardians and child have their own individual CRN number.

Parent/Guardian 1
Family name:*	Given name(s):*
Relationship to child:	Does the child live with you? Yes No Shared Care
Comments/Details:
Same address as child's Street:* Suburb:* Postcode:*
Home Phone:* Work Phone: Mobile Phone:*
Email:*	Confirm Email:*
Occupation:	Casual Full-Time Part-Time
Employer:	Employer Phone:
Employer Address:

Parent/Guardian 2
Family name:*	Given name(s):*
Relationship to child:	Does the child live with you? Yes No Shared Care
Same address as child's Street:* Suburb:* Postcode:*
Home Phone:* Work Phone: Mobile Phone:*
Email:*	Confirm Email:*
Occupation:	Casual Full-Time Part-Time
Employer:	Employer Phone:
Employer Address:

Booking Information

Will your child be attending on a permanent or casual basis?

Permanent Casual

Staff will be allocated for this child’s attendance in advance. As such you will be billed for this attendance even if your child fails to attend

Please select the date period for which this booking will apply:

** Your booking will commence on this date and continue until such time as written notification of change or cancellation of the booking has been received at our head office. Written notification is required for changes to both attendance day and preferred 'drop off' and 'pick up' times.

Please select the days that you would like your child to attend:

Session	Monday	Tuesday	Wednesday	Thursday	Friday
Morning
Afternoon

Please select a drop off and pick up time

Operating Times:

Morning:
Afternoon:

Child Health Information

Has your child been assessed / or do you wish to have your child assessed for any additional needs. (NB if your child has been assessed in the following areas please provide documentation in relation to the assessment)

Asmtha	Gifted/Talented	anaphylaxis/or other food allergies
A.D.D/A.D.H.D	Speech	Behavioural Conditions

Other?

Yes No

If yes, please provide relevant details below, including frequency, severity, treatment and action:

Has your child ever experienced any language or speech difficulties?

Has your child any Current Medical Treatment?

Does your child have any proven allergies?

Does your child have any special dietary requirement - food & products not allowed

Immunisation Information

Has your child had?
Measles Mumps German Measles Chicken Pox
Ear Infection Throat Infection Hepatitis

Children enrolling in child care must provide continuing proof of current immunisation status. Failure to provide this proof will mean that your child will not be able to attend the centre should there be an outbreak of a vaccine-preventable disease – and fees will be charged during this period.

Medicare Number:

Child's reference number:

Valid to date:

Does your child have any great fears?

Please state any religious or cultural requirements we need to abide by whilst caring for your child

Is your child toilet trained? Yes/No

(NOTE If your child is 3 years + they must be fully toilet trained to attend Preschool)

Special words your child uses when wanting to use the toilet

Does your child sleep in the daytime?

Yes No

Does your child need a security toy/item to sleep with?

Does your child celebrate Christmas?

Yes No

Does your child celebrate Easter?

Yes No

Does your child celebrate Birthdays?

Yes No

How may we best help your child this year?

What information do you consider is important to know upon collection of your child each day, and what is the best means of conveying this to you?

Do you wish your child to participate in non-denominational scripture lessons?

Yes No

Would you like all written correspondence in English? Yes/No

EMERGENCY DETAILS

Please attach any court orders pertaining to your child and give any additional information. The Authorised Supervisor must sight original legal documentation before photocopying them to add to your child’s file. A photograph of any unauthorised persons is required to aid staff in prompt identification of improper persons.
Please be aware that we are legally mandated to report any suspicion of Risk of Harm that may be apparent to any attending child and their family members.

Family Doctor:	Doctor's phone:
Street: Suburb: Postcode:

Do you give the centre Authority to call an Ambulance if required?	Yes No
Do you have any religious requirements in the case of an emergency?	Yes No

If yes, please detail:

EMERGENCY CONTACTS

The following information is very important please think carefully before completing. These are person’s other than the child’s parents/guardian that are permitted to drop off and collect your child. NOTE Persons you list below must be over the age of 18.

Authorised Nominee 1
Family name:	Given name(s):
Relationship to child:
Street: Suburb: Postcode:
Home Phone: Work Phone: Mobile Phone:

Authorised Nominee for emergency contact Do you authorise this person to be contacted by centre staff in the case of a serious incident or emergency if you or the other nominated parent / guardian are not able to be contacted?	Yes No
Authorised Nominee for medical attention Do you authorise this person to consent for medical treatment from a registered medical practitioner, hospital or ambulance service for your child?	Yes No
Authorised Nominee for administration of medication Do you authorise this person to authorise the administration of medication to your child by centre staff?	Yes No
Daily pick up Do you authorise this person to pick up your child?	Yes No

Full name of parent/guardian:	Relationship to Child:
Signature:

Authorised Nominee 2
Family name:	Given name(s):
Relationship to child:
Street: Suburb: Postcode:
Home Phone: Work Phone: Mobile Phone:

Authorised Nominee for emergency contact Do you authorise this person to be contacted by centre staff in the case of a serious incident or emergency if you or the other nominated parent / guardian are not able to be contacted?	Yes No
Authorised Nominee for medical attention Do you authorise this person to consent for medical treatment from a registered medical practitioner, hospital or ambulance service for your child?	Yes No
Authorised Nominee for administration of medication Do you authorise this person to authorise the administration of medication to your child by centre staff?	Yes No
Daily pick up Do you authorise this person to pick up your child?	Yes No

Full name of parent/guardian:	Relationship to Child:
Signature:

Authorised Nominee 3
Family name:	Given name(s):
Relationship to child:
Street: Suburb: Postcode:
Home Phone: Work Phone: Mobile Phone:

Authorised Nominee for emergency contact Do you authorise this person to be contacted by centre staff in the case of a serious incident or emergency if you or the other nominated parent / guardian are not able to be contacted?	Yes No
Authorised Nominee for medical attention Do you authorise this person to consent for medical treatment from a registered medical practitioner, hospital or ambulance service for your child?	Yes No
Authorised Nominee for administration of medication Do you authorise this person to authorise the administration of medication to your child by centre staff?	Yes No
Daily pick up Do you authorise this person to pick up your child?	Yes No

Full name of parent/guardian:	Relationship to Child:
Signature:

PRIVACY STATEMENT

Our centre maintains records of children’s attendance, health, family financial matters, such as fee payments, and the developmental records of each child as required by regulations. All information is confidential and is only available to parents/guardians of the children concerned and by the request of FACS, NCAC and FAO. Special requirement records will be kept, if notified by a parent, which may relate to a child’s culture or religion or if the child has a disability or other special need. The specific needs of all children will be recorded.

PARENTAL AGREEMENT - Failure to agree to the following will result in termination of enrolment

In the event of any emergency, illness or accident concerning my child, I hereby give my permission for the staff at this centre to seek medical, dental, or hospital attention for my child. Also, if every reasonable effort to contact me has failed and the Doctor/Dentist contacted considers it necessary for medication, anaesthetic or minor surgery to be necessary he/she has my permission to administer same. My authority is given for transport by ambulance to the nearest casualty department and to be treated via hospital protocol.

I accept liability for any medical, dental and/or ambulance expenses which may occur while my child is at the Centre.

Name:

Signature:

I hereby give permission for my child to be given age appropriate dosage of Panadol (as specified on the packaging) in case of illness, once all attempts have been made to contact me for verbal permission.

Name:

Signature:

I understand that allocated parking is the only acceptable form of arrival/departure at this centre. I understand that I must hold my child’s hand whilst moving to and from the parking area, drive in a forward motion at 5kms only, and reverse park into allocated car spaces when parking.

Name:

Signature:

I give permission for my child to attend non-denominational scripture lessons provided by a qualified scripture Teacher

Name:

Signature:

I give permission for the staff at this centre to take photographs and videos of my child involved in play experiences for the purposes of promoting the service as a high quality centre. This involves accreditation, newspaper articles, portfolio observations, and displays within the service.

Name:

Signature:

I give permission for the staff at this centre to display my child’s date of birth on a BIRTHDAY CHART, name on a locker chart, and take frequent observations of my child for developmental progress, and educational purposes.

Name:

Signature:

I, and my partner, have read the centre’s Parent Handbook, and agree to abide by all conditions, policies and procedures as outlined and stated herein. I also agree to abide by the centre’s policy of maintaining fees two (2) weeks in advance. I also understand that fees are to be paid for all days that my child is absent, sick, or on holidays, and that if fees shall fall into arrears, my child’s place at the centre will be jeopardised.

Name:

Signature:

TERMS & CONDITIONS

I have read and understand the following conditions:

NEW ENROLMENT FEE: All new enrolments (for new centres only) are required to pay $100.00 holding fee. This $100.00 is to secure your position at the centre. Upon commencement of enrolment, this enrolment fee will be deducted from the Holding Deposit. If enrolment is not commenced, the $100 is not refundable.
HOLDING DEPOSIT: Upon enrolment two (2) weeks' worth of fees are to be taken and held on your account as a Bond and refunded to your account upon termination of placement. This must be paid by cheque or money order, prior to your child's commencement.
FEES IN ADVANCE: Fees must be paid two (2) weeks in advance at all times, if my fees fall into arrears my child may lose his/her position. This must be paid by cheque or money order, prior to commencement.
FEES PAID BY DIRECT DEBIT: All fees are to be made via Direct Debit. Complete and return the attached Direct Debit form, prior to commencement.
LATE FEE: There is a late fee of $10.00 for the first 10 minutes or part thereof and for every additional minute $5.00 will be charged. This is to be paid as an “on the spot fee” when late in collecting your child/ren.
ABSENT DAYS: Sick days and any other days your child is absent must be paid for. Please note that the Family Assistance Office will only allocate 30 allowable absences per calendar year before your Child Care Benefit is revoked.
CHANGE OF DAYS: Two weeks written notice must be given if you require additional days or are reducing the days your child currently attends. Extra days are subject to availability and Priority of Access.
TERMINATION NOTICE: Two weeks written notice must be given if your child is leaving the Centre.
MEDIA DISPLAY: Videos, photographs, and audios of your child are authorised by you (the parent/guardian) to be taken, transmitted, and distributed whilst your child is in our care for marketing and display purposes.
SUN CREAM: Sun cream is to be applied to your child/ren by you upon arrival at our service, and given a stamp on their hand as an indicator to our staff of your adherence to this principle.
HANDWASHING: All staff, children, parents and visitors to our Centre are to wash their hands upon arrival to minimize the spread of infections throughout our service.
PARKING: All cars are to be parked in our allocated car spaces parked rear to kerb. Parents are not permitted to park/drop off their children whilst paused on the road surrounding our service. A 50km limit must be abided by whilst moving within our car-park

Name:

Signature:

Payment Options

Payment Type:

I hereby consent to you deducting my weekly fees from my credit card account. I understand that this will be an ongoing instruction until I give you two weeks notice to cancel. A 3% surcharge will be levied on every transaction.

Credit card type:

Credit Card Number:

Credit Card Expiry Date:

Credit Card Name:

Direct Debit Request

ACN:

Request and Authority to debit the account named below to pay

Request and Authority to debit

Surname or Company Name:*

Given Names or ACN/ARBN:* ("you")

request and authorise to arrange for weekly fees may debit or charge you to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement [and any further instructions provided below].

Insert the name and address of financial institution at which account is held

Financial institution name:*

Address:*

Insert details of account to be debited

Name of account:*

BSB number:*

Account Number:*

Acknowledgment

By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between you and as set out in this Request and in your Direct Debit Request Service Agreement.

Payment Details

The first debit may be made on the first Tuesday of your week’s attendance, then every Tuesday in advance thereafter.

Insert your name and address

Name:*

Address:*

Date:*

Direct Deposit Request Service Agreement

Definitions

account means the account held at your financial institution from which we are authorised to arrange for funds to be debited.

agreement means this Direct Debit Request Service Agreement between you and us.

business day means a day other than a Saturday or a Sunday or a public holiday listed throughout Australia.

debit day means the day that payment by you to us is due.

debit payment means a particular transaction where a debit is made.

direct debit request means the Direct Debit Request between us and you us or we means , the Debit User you have authorised by signing a direct debit request.

you means the customer who signed the direct debit request.

your financial institution is the financial institution where you hold the account that you have authorised us to arrange to debit.

1. Debiting your account

1.1 By signing a direct debit request, you have authorised us to arrange for funds to be debited from your account. You should refer to the direct debit request and this agreement for the terms of the arrangement between us and you.

1.2 We will only arrange for funds to be debited from your account as authorised in the direct debit request.

1.3 If the debit day falls on a day that is not a business day, we may direct your financial institution to debit your account on the following business day. If you are unsure about which day your account has or will be debited you should ask your financial institution.

2.Changes by us

2.1 We may vary any details of this agreement or a direct debit request at any time by giving you at least fourteen (14) days’ written notice.

3. Changes by you

3.1 Subject to 3.2 and 3.3, you may change the arrangements under a direct debit request by contacting us on 1300 553 583

3.2 If you wish to stop or defer a debit payment you must notify us in writing at least two (2) weeks before the next debit day. This notice should be given to us in the first instance.

3.3 You may also cancel your authority for us to debit your account at any time by giving us two (2) weeks notice in writing before the next debit day. This notice should be given to us in the first instance.

4. Your obligations

4.1 It is your responsibility to ensure that there are sufficient clear funds available in your account to allow a debit payment to be made in accordance with the direct debit request.

4.2 If there are insufficient clear funds in your account to meet a debit payment:

(a) you may be charged a fee and/or interest by your financial institution;

(b) you may also incur fees or charges imposed or incurred by us; and

(c) you must arrange for the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so that we can process the debit payment.

4.3 You should check your account statement to verify that the amounts debited from your account are correct

4.4 If is liable to pay goods and services tax ("GST") on a supply made in connection with this agreement, then you agree to pay on demand an amount equal to the consideration payable for the supply multiplied by the prevailing GST rate.

5. Dispute

5.1 If you believe that there has been an error in debiting your account, you should notify us directly on 1300 553 583 and confirm that notice in writing with us as soon as possible so that we can resolve your query more quickly.

5.2 If we conclude as a result of our investigations that your account has been incorrectly debited we will respond to your query by arranging for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted.

5.3 If we conclude as a result of our investigations that your account has not been incorrectly debited we will respond to your query by providing you with reasons and any evidence for this finding.

5.4 Any queries you may have about an error made in debiting your account should be directed to us in the first instance so that we can attempt to resolve the matter between us and you. If we cannot resolve the matter you can still refer it to your financial institution which will obtain details from you of the disputed transaction and may lodge a claim on your behalf.

6. Accounts

You should check:

(a) with your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions.

(b) your account details which you have provided to us are correct by checking them against a recent account statement; and

(c) with your financial institution before completing the direct debit request if you have any queries about how to complete the direct debit request.

7. Confidentiality

7.1 We will keep any information (including your account details) in your direct debit request confidential. We will make reasonable efforts to keep any such information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification, reproduction or disclosure of that information.

7.2 We will only disclose information that we have about you:

(a) to the extent specifically required by law; or

(b) for the purposes of this agreement (including disclosing information in connection with any query or claim).

8. Notice

8.1 If you wish to notify us in writing about anything relating to this agreement, you should write to 14 Ravensbourne Circuit, Dural 2158.

8.2 We will notify you by sending a notice in the ordinary post to the address you have given us in the direct debit request.

8.3 Any notice will be deemed to have been received two business days after it is posted.

Signature: *

	CRN's provided		Medicare number provided		Medical form (if applicable)
	Photocopy of license/passport		Special Needs form (if applicable)		Payment schedule given

Does your child have a need for additional assistance in any of the following areas, compared to a child of similar age? *

Priority of Access

CCB and CCR information

PARENTAL AGREEMENT - Failure to agree to the following will result in termination of enrolment

Direct Debit Request

Request and Authority to debit

Insert the name and address of financial institution at which account is held

Insert details of account to be debited

Acknowledgment

Payment Details

Insert your name and address

Direct Deposit Request Service Agreement

Definitions

1. Debiting your account

2.Changes by us

3. Changes by you

4. Your obligations

5. Dispute

6. Accounts

7. Confidentiality

8. Notice