After School Care/Before School Care Enrolment Form

Please complete the enrolment form below to enrol your child in our before school or after school care programmes.

Child's Details

Childs Name (required)

MaleFemale (required)

Address (required):

City (required)

Post Code

Child's Birth Date (required) Childs Age (required)

School (required)

Room

Medical Allergies/Conditions

Special Diet

Doctors Name

Doctors Phone Number

Ethnicity (Optional)

Are there any matters of a cultural nature that you would like us to consider when programme planning?

Enrolment Details

Please Note: You are charged for days and hours booked (this includes casual or rostered bookings) regardless of early collections or absences. This also includes Public Holidays. 1 week’s cancellation notice is required.

Care Required:
Permanent Space @ $6.15 per hour
Casual Space @ $7.00 per hour
Rostered Space @ $6.15 per hour

Monday

Tuesday

Wednesday

Thursday

Friday

First Contact

Full Name (required)

Relationship to child (required)

Occupation

Address (if different from the Child's)

City

Post Code

Home Phone Number (required):

Work Phone Number:

Mobile Number (required):

Email Address (required):

Second Contact

Full Name

Relationship to child

Occupation

Address (if different from the Child's)

City

Post Code

Home Phone Number

Work Phone Number

Mobile Number

Email Address:

Additional Contact Person/s Who Can Collect Your Child

First Additional

Full Name

Relationship to child

Home Phone Number

Work Phone Number

Mobile Number

Email Address:

Second Additional

Full Name

Relationship to child

Home Phone Number

Work Phone Number

Mobile Number

Email Address:

Person/s Who Are Not Permitted To Collect Your Child

First Non Permitted

Full Name

Relationship to child

Second Non Permitted

Full Name

Relationship to child

Authorisation Agreement

In giving consent for my child/ren to participate in the Before and After School Care Programme I agree to the following conditions.

  • I have read and understand the Information for Parents
  • I will notify the Programme Manager of any permanent changes to enrolment details
  • I will notify the Programme Supervisor of any absences or changes to daily enrolment
  • I agree to pay fees according to Terms of Trade
  • I understand that days and hours booked will be charged for and that I will be charged for Public Holidays that fall during the school term
  • If any outstanding debt is longer than 60 days I understand that the account will be passed onto a collection agency and additional fees will be added on

Use of photos, videos etc for Website and Facebook?

Please state whether you are comfortable for us to use any photos or videos that we take for advertising on our Website or Facebook page.

AgreeDisagree (required)

Declaration

Please check this box below if you declare the above information is correct