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