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Murray Children's Centre Updated Enrolment Form Name of person/s responsible for payment of fees? Child details First Name: Middle Name: Last name: Child CRN: Date of Birth: Parent 1 details Gender: F/M Parent 2 details Last name: First name: Middle Name: CRN: CRN: Date of Birth: Date of Birth: Gender: F/M Gender: F/M Address: Home phone: Mobile: Home email: Occupation: Work phone: Work email: Murray Children's Centre Updated Enrolment Form Child health details Medical conditions: Special Dietery Requirments: Allergies: Emergency contact 1 details Name: Home phone: Work phone: Mobile: Relationship: Address: Doctor/Health fund details Doctor's name: Doctor's Phone: Doctor's address: Medicare no: Private Health fund: Health Fund Number: Ambulance Subs no: Emergency contact 2 details Murray Children's Centre Updated Enrolment Form Collection contacts 1 details Collection contact 2 details Name: Home phone: Work phone: Mobile: Relationship: Address: Immunisation Statement Attached (Obtained from Medicare) Birth Certificate Copy Provided YES / NO Child other details Child lives with (if other than parent): Parent activity: Working (incl. more than 15 hrs pw voluntary) Looking for work Studying/training only Disability or caring for someone with a disability None of the above Is child of Aboriginal or Torres Strait Islander Origin? Yes, Aboriginal Yes, Torres Strait Islander No YES / NO Murray Children's Centre Child disability? Updated Enrolment Form Yes/No Definition of a child with a disability: Does this child have a need for additional assistance in any of the following areas, compared to children of a similar age, that is related to an underlying long-term (lasting more than 6 months) health condition or disability? Tick the appropriate boxes. The categories include: Learning and applying knowledge, education Communication Mobility Self Care Interpersonal interactions and relationships Other - including general tasks, domestic life, community and social life The definition of a child with a disability does NOT include children with a medical condition that is short term (lasts for 6 months or less) or episodic. For example, asthma, allergies, eczema, infectious diseases. Child special needs? Yes/No Children with special needs are those from the priority groups below. Tick the appropriate boxes. Children from culturally and linguistically diverse backgrounds Children with a refugee background who have been subjected to trauma Indigenous children The child's place has been sought by a state or territory child protection worker The child is in the care of the state or other forms of out of home care Murray Children's Centre Updated Enrolment Form Court Orders: Are there any court orders relating to the powers and responsibilities of the parents in relation to the child or access to the child? No Yes go to the next section please complete this section Murray Children's Centre Court Order Information ABN: 83 878 708 551 Child name: Date of birth: Are there any court orders relating to the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child? YES/NO If yes, complete next section: 1. Bring the original court order/s for staff to see and a copy to attach to this enrolment form. 2. If these orders: a. Change the powers of a parent/guardian to: - Authorise the taking of the child outside the service by a staff member of the service - Consent to the medical treatment of the child - Request or permit the administration of medication to the child - Collect the child AND/OR b. Give these powers to someone else, Please describe these changes and provide the contact details of any person given these powers: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Murray Children's Centre Updated Enrolment Form Murray Children's Centre Declaration and Emergency Medical Treatment Consent ABN: 83 878 708 551 Child name: Date of birth: I, (Print full name) a person of lawful authority of the child referred to in this enrolment form, agree to collect or make arrangements for the collection of the child referred to in this enrolment form if he/she becomes unwell at the service; consent to the staff of the children's service seeking, or where appropriate, administering, such emergency medical, hospital, dental or ambulance services, or treatment as is reasonably necessary and that I will reimburse any necessary expenses incurred by the children's service; understand that in an emergency situation or fire drill where evacuation is necessary that my child may need to leave the preschool/childcare premises under the direction and supervision of staff; declare that the information in this enrolment form is true and correct and undertake to immediately inform the children's service in the event of any change to this information; will refer to the Service Policy Documentation for further information. Signature Date Authorised Service Signature Date Lawful Authority Parents All parents have powers and responsibilities in relation to their children which can only be changed by a court order. The Children's Services Regulations 1998 refer to these powers and responsibilities as "Lawful Authority". It is not affected by the relationship between the parents, such as whether or not they have lived together or are married. A court order, such as under the Family Law Act, may take away the authority of a parent to do something, or may give it to another person. Guardians A guardian of a child also has lawful authority. A legal guardian is given legal authority by a court order. The definition of "guardian" under the Children's Services Act 1996 also covers situations where a child does not live with his or her parents and there are no court orders. In these case, the guardian is the person the child lives with who has day-to-day care and control of the child. Murray Children's Centre Updated Enrolment Form Fees A daily fee of $80.00 is charged. Included in fees Lunch Morning and Afternoon Tea Nappies Sun-screen All linens The Charles Sturt University Division of Finance is responsible for our banking policies and procedures. Fees may be paid by cash, cheque or EFTPOS at the Administration Office Monday to Friday 8.00am – 6.00pm. University staff can arrange to have the fees deducted from their pay as salary sacrificing or payroll deduction. Receipts are issued on payment of fees. If at any time parents are experiencing financial difficulties, please contact our Administration Officer to make arrangements to set up a payment plan. The centre produces accounts after the care has been provided for the week. Invoice/Statements are placed outside your child’s room in your child’s pocket for your collection. Our terms and conditions are Fees are due within 7 days of care. Each day booked must be paid for regardless of whether your child attended or not, this includes Public Holidays (If your child is booked in to care on a day which a Public Holiday falls on, we are unable to swap for an alternative day). Fees are not charged over the observed university holidays while the centre is closed. Please remember that the Centre closes at 6.00 pm. If you are unavoidably delayed, please notify the staff by phone. A Late fee of $5 per five minutes will be charged. Regulations state that 2 staff members must be in the Centre whenever any child is in attendance. Two weeks written notice of withdrawal or reduction of days is required by the Centre when you choose to leave or reduce your child’s attendance. All fees must be finalised prior to departure. Fees MUST be paid when due. Overdue fees may result in cancellation of your child’s enrolment at the Centre and action being taken by the University to recover the debt. Additional costs resulting from the debt recovery action will be an additional liability to the debtor. Additionally, students may have their results withheld and enrolment cancelled if they have outstanding debts. I have read and I agree to the terms and conditions above, Parent 1 Name Signature Date Parent 2 Name Signature Date