Primary Guardian Details Miss Ms Mrs Mr Other _______ Name CRN

1. Enrolment Form Highfields Early Learning Centre 93 Highfields Road Highfields QLD Ph: 4615 5688 Child DetailsFirst Name: Last Name:Child CRN: Male Female DOB: ___/___/___COB: Language Spoken:Is the child of Aboriginal and/or Torres Strait Island Origin? (please tick) No, not Aboriginal or Torres Straight Islander Yes, Aboriginal Yes, Aboriginal and Torres Straight Islander Yes, Torres Straight Islander Primary Guardian Details Miss Ms Mrs Mr Other _______ Name CRN Mobile Email Male Female DOB ___/___/____ COB Home Address Home Phone Mobile Martial Status Relation to Child Authorised to Collect the child? Yes No Secondary Guardian Details Miss Ms Mrs Mr Other _______ Name CRN Mobile Email Male Female DOB ___/___/____ COB Home Address Home Phone Mobile Martial Status Relation to Child Authorised to Collect the child? Yes No Booking Information Date starting: Monday Tuesday Wednesday Thursday Friday Parent / Guardian Details (if Secondary Guardian details are the same write “same as Primary Guardian 1)

2. Employment Details Secondary Guardian Details Employer Name Work Address Work Phone Email Occupation Primary Guardian Details Employer Name Work Address Work Phone Email Occupation Emergency Contact Details Approved persons will be contacted in emergency situations when the parents or guardian is not available (in order as listed). They are also authorised to sign out children from the centre without additional written permission. Please supply at least two names, other than the parents/guardians, whom we may contact in the event of an emergency. Contact 1 Name Mobile Phone (H) Address Phone (W) Relationship to child Email Address Do you authorise this person to collect your child? Yes No Contact 2 Name Mobile Phone (H) Address Phone (W) Relationship to child Email Address Do you authorise this person to collect your child? Yes No Contact 3 Name Mobile Phone (H) Address Phone (W) Relationship to child Email Address Do you authorise this person to collect your child? Yes No

3. Family Details Page Please provide details of any siblings or other family members that live in your household Name Relationship DOB Name Relationship DOB Name Relationship DOB Name Relationship DOB Name Relationship DOB Family Profile Ethnicity Religion Can your child speak English? Can you child understand English? Would an interpreter be of benefit of the child during the settling in period? __________________________________ What religious or cultural practice would you like your child to observe? (please give details below_ Are they are any activities at the centre which may contravene your family values or beliefs? Can you help with any of the following items to assist us to share and enhance your culture with the centre? Posters Artefacts Cookery Dolls Musical Instruments Dress Up Clothes Other items Is their any other information you would like to share with us about your background/beliefs? School Information Does this child usually attend School? Yes No When was, or when will this child be enrolled at school? Child Custody Information If parents are separated/divorced, it there a legal document specifying who has custody or or access to the child ? No (go to the next section) Yes (please complete the following) Name of the custodial parent: Any additional information about access arrangements Is their any court orders against a parent or family member? No (go to the next section) Yes(please complete the following) Name of person Date of Issue Is a copy of Court order attached? Yes No If you have any further information and/or photos of this person please hand this to the director on enrolment

4. Health & Medical Information Contact details for Health Professions Doctors Name Phone Address Dentist Name Phone Address Medicare No Private Health Insurance Name & No Preferred Hospital in Emergency Does your child have any allergies? No (go to next question) Yes (please complete the following) Anaphylaxis Has your child been diagnosed at risk of anaphylaxis ? No Yes (please attach action plan) Does your child have an epipen? No Yes Has the anaphylaxis management policy for the centre been provided to you? No Yes Has the risk minimisation plan been completed by the centre in consultation with you? No Yes If you answer yes to any of the questions below you must provide a support letter from your local doctor Allergies Is your child Allergic to any food? No Yes If yes, pleas specify which foods and the signs / symptom's to be aware of. Is their any other allergies? No Yes If yes please detail and specify the signs / symptom’s to be aware of Asthma Has your child suffer from Astham? No Yes (please attach action plan) Does your child use ventolin? No Yes Has the asthma management policy for the centre been provided to you? No Yes Has the risk minimisation plan been completed by the centre in consultation with you? No Yes llness /Injury /Medical etc Does your child have a history of illnesses or injuries? No Yes (please provide details) Does your child have a any current medical condition? No Yes (please provide details) Is the medical condition a long Term condition ? No Yes (please fill out a Long Term Medical Conditions Action Plan) Is your child currently on any prescribed medications? No Yes (please provide details) Does you child have any special needs? No Yes (please provide details)

5. Immunisation Details To be eligible for childcare Benefit, your children must meet the immunisation requirement's if they are under the age of seven. Please see family Handbook for further information Please detail your child’s immunisations to date in the table below The National Immunisation Program Valid from July 2013 I understand that in the event of an outbreak of a vaccine preventable disease at the centre, the management must notify the Department of Health of an unimmunised children in the centre and that they will be excluded from attendance for such time as the Department deems necessary and that the daily fee is still applicable during this time. Parent/Guardian Signature: ______________________________ Date: ______________

6. Child Profile The following information pages will be share with your child’s educators. Child’s Name: Date of Birth: ___/___/____ Usual time awake: Usual evening bedtime Daytime sleep (approximate time of day and length) What does your child take to bed? Any special bedtime routines Are the any foods your child particularly likes or dislikes? Does your child have any fears? (e.g noise, animals) Does your child get upset when left with other people? Does your child have any favourite songs and/or activities they play at home? Language spoken by the child Languages spoken at Home Cultural Background Does your child have any disabilities or special needs? What home discipline methods do or would you use? Has your child been in care before? No Yes (please state what type of care) Are they are any words that we may need to know that have special meaning to your child How can we assist your child? What would you most want for your child at our centre? Are there any particular areas of concern that you feel we need to know about What information do you consider important for you to know each day and what is the best means of communicating this with you? Is there any further information which you feel may assist us in providing the service best suited to your needs and the needs of your child? (e.g recent significant events, family situations, religious beliefs etc) Are their any skills that your or family members have that you would like to contribute to the Centres program

7. Information Required for Children under 3 years of age Pleas tick where appropriate and provide comments where necessary. Eating Routines Feeds self Uses spoon or utensils Uses cup Uses bottle Nursery Children Toileting Routines Nappies Being toilet trained Toilet Trained Sleeping Routines Sleeps in cot Sleeps in Bed Nursery Children

8. CCB & CCR Information To ensure that you are linked to our centre through the Child Care Management System (‘CCMS’) and to have Child Care Benefit (CCB) and Child Care Tax Rebate (CCTR) applied to your child care fees, you must contact Centerlink to link you up to CCB & CCTR. , please also confirm that they have the correct name and date of birth for both the parent and child who is registered for CCB. Do you have any other children in care elsewhere No Yes (please list your other children below) I understand that it is my responsibility to let the center know in writing if my other children stop using care elsewhere. I understand that I am responsible for communicating with Centerlink. I understand that if any details are incorrect then full child care fees are payable by me directly to the center until the details are corrected with centerlink. Parent/Guardian Signature: _______________________________________________ Date Allowable Absences Each family is allowed 42 allowable absences each financial year. If you exceed 42 you will not be eligible to receive CCB for any absence days after this amount. If you are coming tpHighfields Early Learning Centre from another centre you must advise us of any previous absences accumulated in the current financial year. Please tick one of the following: I am coming from another centre. My total allowable absences taken for this financial year thus far are ______ days. I have not attended another centre this financial year, therefore I have no previous allowable absences accumulated. Parent/Guardian Signature: ________________________________________________ Date

9. Fee Information Fees are to be paid weekly in advanced , you have the following options to pay your account: please tick the relevant box in which you are going to pay your fees. Ezi Debit Centerpay Cash EFTPOS Direct Deposit ([please fill in the code you will use for payments of your fees) I will be paying Weekly Fortnightly I agree to pay my fees according to what has been ticked above, I agree that if I miss one payment I will make the full amount owing on the next payment.. I understand that accounts are not to be more than 3 weeks behind, if they get to 3 weeks behind I will either pay the account in full or organise a payment plan, I agree that if I don’t either pay the account in full or organise a payment plan then my child's position at the centre will be cancelled. Signature Name of Parent Date Statement & Communication Options Statements Parent Statements are sent out on a weekly basis you can choose to receive them either by email or a printed copy, please tick according to how you would like to receive these statements Email Print Communication We communicate to families in a range of ways (please see family handbook for more in depth details). We have monthly newsletters and also notes on upcoming events would you prefer to receive these by email or printed copy, please tick according to how you would like to receive written communication Email Print I give permission for the rooms to email my photos of my children throughout the year. I understand it is my responsibility to inform the centre if my email changes or I wish to change the way I receive the above information Signature Name of Parent Date

10. Enrolment Agreement Parents/Guardian’s must read and initial each section of the enrolment agreement. Initial & signing this form means that have read and agreed to each of the terms. 1. Fees I / We understand and accept that fees must be paid a week in advance including public holidays, for which my child is enrolled whether or not he/she is in attendance. I understand that that if my child is not collected from the centre by closing time I will incur a late fee penalty as specified in the Family Handbook. I understand that if my fees go over 3 weeks in arrears that my child’s spot at the centre could be in jeopardy. 2. Notice upon leaving Highfields Early Learning Centre I / We am aware that two weeks notice must be given to the Director when terminating my child’s place. If this is not done, I will incur the normal full fee for this interim period 3. Emergency Administration of Paracetamol I / We give permission for a senior staff member to administer paracetamol to my child in the event of a temperature exceeding 38 degrees celsius and emergency contacts cannot be reached 4. Emergency or Accidents In the event of an emergency, illness or accident (when the Centre is unable to contact the Parent / Guardin or the Authorised Contacts), I / We give the staff at the centre consent to seek Medical or Hospital attention for our child. I / We agree to pay any expenses incurred for Medical treatment and transport. 5. Permission for Observations I / We give permission for our child to be observed for staff, student or visitor purpose. Students and visitors will work in conjunction with your child’s educators. If questioning or testing is to be carried out ! / We will be asked for further permission. 6. Permission for Photographs I / We consent to my child being photographed for the following purposes: Inclusion in their individual child portfolios, centre programming (displays in the centre),Inclusion of my child’s photo in their friends portfolios, newsletters. I understand if my child photo is to be used in public places (Facebook, Website, Marketing Materials etc) I will be asked for written permission. 7. Physical Wellbeing I / We give permission to Highfields ELC to apply SPF30+ sunscreen to any unprotected areas of skin on my child when they are outside. ! / We agree for Centre staff to apply Insect Repellant to ur child where necessary for indoor or outdoor purposes. I / We consent to First Aid being administered to my child by a staff member who holds a First Aid Certificate. I/ We agree that all medicine, whether prescribed or non-prescribed, will be administered by staff according to instructions given by a medical practitioner. I / we will fill out a form giving full details of dosage and times required based on medical advice. I / We understand that the centre will notify me immediately if my child is sick, and I will arrange for the child to be picked up from the centre immediately. 8. Authorised Contacts for collection I / We agree to give permission for people listed on this form as authorised to collect my child to do so, unless I notify the Director, in writing of any changes. 9. Leaving the Property I / We agree to give permission for my child to move out of the centre grounds when necessary for situations such as fire drills. 10. Parent Handbook 1 / We acknowledge that we have received and read the Centre’s Family Handbook. I / We understand any changes to this handbook will be displayed on the Family communication board in the foyer area. 11. Centre Policies I / We acknowledge that the Centre Policies are avaible in the centre foyer at all times to view. I / We understand that these policies will be reviewed on an ongoing basis, and that the centre director will ask for input on these reviews from us families. I / We understand any changes to polices that is relevant to families will be displayed in the foyer area.

11. 12. Fees for Public Holidays • I / We understand that Public Holidays are charged at the normal daily fee rate and that complimentary make-up days will not be available. • 13. Infectious Diseases / Clearance Certificates • I / We understand that our child will be excluded from the Centre if they contract a contagious disease or condition. I / We understand that our child will not be accepted back into the centre until a ‘clearance certificate’ is issued from a Medical Practitioner. Please refer to our Centre Policies for further information. • 14. Presence of Visitors and Volunteers • I / We understand that occasionally the Centre may have visitors and/or volunteers assisting in the Centre. I / We consent to our child being in the presence of visitors and/or volunteers under the centre staff supervision. • By signing this form I / We declare and confirm: • I / We are lawfully authorised in relation to the child referred to in this enrolment form • All information provided in this Enrolment form is true and correct • I / We have read, fully understand and agree to comply will all of the polices and procedures detailed in this enrolment form including items 1 – 14 above, and any other policies and procedures advised by the centre either directly or by making them available for perusal at the centre. • Signature of Primary Parent / Guardian Date