Online Enrolment Application Form

Select Group
Mon/Tues (4yo)Mon/Thurs (4yo)Tues/Thurs (4yo)Friday (3 yo)

Start date (dd/mm/yyyy):

Your Child

Family Name: Given Names:
Usually Called: Gender
MF
Date of Birth (dd/mm/yyyy):
Country of Birth:
Language/s spoken/understood
Cultural Background Religion
Home Address Best Contact Phone Number
Is the child of Aboriginal or Torres Strait Islander Descent? YesNo

Your Family Information

Parent/Guardian 1 Parent/Guardian 2
Name: Name:
Relationship to Child: Relationship to Child:
Date of Birth (dd/mm/yyyy): Date of Birth (dd/mm/yyyy):
Address (Same as child or) Address (Same as child or)
Does the child live with this parent/guardian? YesNo Does the child live with this parent/guardian? YesNo
Language/s spoken/understood Language/s spoken/understood
Occupation: Occupation:
Contact Details Contact Details
Mobile Mobile
Home Home
Work Work
Email Email

Court Orders, Parent Orders or Parenting Plans Relating to your Child

Are there any court orders, parenting orders or parenting plans relating to the powers and responsibilities of the parents in relation to the child or access to the child?
YesNo
if YES please:

-Bring the original court order/s, parenting order/s or parenting plan/s for staff to see and a copy to attach to this enrolment form

-Summarise on a separate page the parts of the Order/s or Plan/s relevant to the child's kindergarten experience in particular if these orders change the powers of a parent/guardian and/or give these powers to someone else.

Emergency Contacts

There may be times when the child has an accident, injury, trauma or illness and the parents/guardians cannot be contacted. Note: Please list people OTHER THAN the child’s parent/guardian.
Emergency Contact 1 Emergency Contact 2
Name: Name:
Relationship to Child: Relationship to Child:
Address (Same as child or) Address (Same as child or)
Contact Details Contact Details
Mobile Mobile
Home Home
Work Work

Authorised Nominee

Authorised Nominee
An authorised nominee is a person who has been given permission by the parent / guardian to collect the child from kindergarten, consent to medical treatment of, or to authorise administration of medication to the child, transportation of the child by ambulance service and if relevant take the child on regular outings such as specialists appointments.
Name:
Relationship to Child:
Address (Same as child or)
Contact Details
Mobile
Home
Work

Your Child's Health Information

Doctor / Medical Service Phone
Address
Maternal & Child Health (MCH) Centre
Does your child have a Child Health Record (from the MCH Centre)?
YesNo
If yes, please bring the Child’s Health Record to the kindergarten to be sighted.
Medicare number Expiry Date (mm/yyyy):
Does your child have Ambulance Membership?
YesNo
Membership No:
Does your child hold Private Health Insurance?
YesNo
Insurer:
Does your child have a Health Care Card? (this is different from Medicare)
YesNo
Health Care Card Expiry Date (dd/mm/yyyy):
If yes, please provide a copy to the Preschool.


Allergies or Sensitivity
Does the child have any allergy or sensitivity (including Asthma)? YesNo
If yes, please provide details of any management procedures that are to be
followed with respect to the allergy or sensitivity.
In the case of asthma you will be provided with a copy of St Johns Kindergarten Asthma Management Policy.
You will be required to provide St Johns Kindergarten with an individual medical management plan for your child signed by
the medical practitioner who is treating your child. This will then be attached to your child’s enrolment form.
Anaphylaxis
Has your child been diagnosed at risk of anaphylaxis? YesNo
Does your child have an auto injection device (e.g. EpiPen/Anapen)? YesNo
Has the anaphylaxis medical management plan been provided to the service? YesNo
Has the risk management plan been completed by St Johns Kindergarten in consultation with you? YesNo
In the case of anaphylaxis you will be provided with a copy of St Johns Kindergarten Anaphylaxis Management Policy.
You will be required to provide St Johns Kindergarten with an individual medical management plan for your child signed
by the medical practitioner who is treating your child. This will be attached to your child’s enrolment form.
Other Medical Conditions
Does your child have any medical conditions or specific health care needs relevant to their care (e.g. epilepsy, diabetes)?
YesNo
If yes, please list below and provide further details including management procedures if applicable that are to be followed with respect to the medical conditions or specific health care needs.
Does the child have any dietary restrictions? YesNo
If yes, the following restrictions apply:
Your Child's immunisation records – NO JAB NO PLAY
Under the new immunisation legislation, all children attending an Early Childhood service MUST be fully immunised. A copy of your child’s full Immunisation History Statement must be held at the kindergarten.
The child is fully immunised and their records submitted to the kindergarten YesNo
If No, a medical exemption from a registered General Practitioner has been provided ? YesNoN/A
If you have not already done so, please attach a copy of the Immunisation History Statement (from the Australian Immunisation Register (AIR). This statement must show they are up to date for their age when they start at kinder.
Attendance at another children's service
Does your child attend another child care, family day care or Kindergarten apart from this centre? YesNo
if yes, please give details:
Name of Centre
Days / Times
St Johns Kindergarten receives government funding for the 4yo program. A child can only attend one funded 4yo program in any year, therefore if also enrolled elsewhere it is your responsibility to advise them that St Johns Kindergarten is receiving funding for your child.
Information for bodies which provide funding to this service
From time to time the Department of Education and Early Childhood Development (DEECD) seeks information on the characteristics of families who use this service. This is used in planning new policies, programs and resources to support services. To help provide accurate information please answer the following questions by ticking the appropriate box indicating Yes or No:
Does the child have any special needs, developmental delay, or disability including intellectual, sensory or physical impairment? YesNo
If yes, please list details below and attach any management procedures or relevant details that may assist staff in planning for your child.
Does either of the Parents / Guardians have a disability? YesNo
Is the family a single parent family? YesNo
Other Family Information
Pets : (name and type of animal):
Please indicate below the days of the week that best suit you to assist as classroom helper. These may be used to develop rosters for classroom help.
MondayTuesdayWednesdayThursdayFriday
Please indicate festivals your family celebrate and/or list below any cultural / religious issues of relevance:
EasterChristmasBirthdaysMother's/Father's DayChinese New Year
Other:
Which school do you intend sending your child to?

Consents

Birthdays
Do you consent to display the birthday date of your child at the kindergarten? YesNo
Photography
Do you consent to your child being photographed:-
for private display eg. Portfolio and developmental observations? YesNo
for the kindergarten internal newsletter? YesNo
for publicity and promotion of the centre via website or printed promotional material eg brochures, information books, boards, banners etc? YesNo
during annual individual and group photos taken by a professional photographer? YesNo
Contact lists
Do you consent for your contact details (phone number and email address) to be distributed to members of your child’s group? YesNo
Do you wish to receive newsletters and information via your e-mail address? YesNo
Sunscreen and Insect Repellent
Do you give permission for St Johns Kindergarten staff to apply, as appropriate:-
SPF 30+ broad spectrum water resistant sunscreen to all exposed body parts of your child YesNo
OR My child is sensitive to some sunscreens. I will provide the kindergarten
with a suitable SPF 30+ broad spectrum UVA/UVB sunscreen and give my permission
for staff to apply this sunscreen.
YesNo
Insect Repellent to all exposed body parts of your child? YesNo
Emergency Evacuations
Do you consent to your child participating in emergency evacuation drills and
practice assembling at designated assembly points as outlined in Emergency Management Plan?
YesNo
Medical Treatment
Do you consent to the staff at St Johns Kindergarten seeking, or where appropriate, administering,
such emergency medical treatment as is reasonably necessary and that you will reimburse any necessary
expenses incurred by the kindergarten in doing so?
YesNo