CHILD'S DETAILS
Select File
:
Gender *
Aboriginal or Torres Straight Islander Heritage? *
ATTENDANCE DETAILS
Days of Attendance - please select confirmed days of attendance: *
PARENT/GUARDIAN DETAILS
Indicate relationship to child of first parent/guardian *
Aboriginal or Torres Straight Islander Heritage? *
Indicate relationship to child of second parent/guardian
Aboriginal or Torres Straight Islander Heritage?
FAMILY INFORMATION
Other Children in the family
Has your child experienced any form of child care before? *
If YES, please specify
If parents are separated or divorced, who does the child reside with?
Are there any court orders of which educators need to be ware that affect how we manage your child's care? *
YOUR CHILD'S HEALTH
Do you have private health cover? *
Has your child been immunised? *
Select File
:
Does your child have any disability, special needs, or a medical condition? *
Does your child have any allergies (i.e. diagnosed as at risk of anaphylaxis)? *
Does your child have any dietary restrictions? *
Is your child on any medication? *
Do you authorise staff to provide your child with paracetamol if their temperature reaches beyond the temperature noted below or over 38 degrees Celsius? *
Does your child need a sleep during the day? *
Is your child toilet trained? *
EMERGENCY CONTACTS AND PERSONS TO COLLECT YOUR CHILD (apart from parents). Authorised persons can be contacted if parents are not available. These persons may also be authorised to consent to medical treatment if the parents can not be contacted.
NOMINEE 1
NOMINEE 2
NOMINEE 3
OTHER INFORMATION
Directions for Correspondence:
Fees will be paid: *
If you are entitled to Child Care Benefit or Child Care Rebate, please indicate:
Did any of the following assist you in choosing the Early Learning Centre for your child? Please tick all that apply. *
$100.00