Enrolment Form

Each person listed above is an Authorised Person in respect of the authorities you have indicated.

Child's Medical & Health Information

Child’s Doctor and Contact Details

Name of Doctor:

Clinic/Practice:

Address:

Phone Number:

Do you have private health insurance? YesNo

Private Health Insurer:

Do you have ambulance cover? Yes *authoriseNo

Medicare Number:

Is your child up to date with the recommended immunisation schedule?

YesNo

Please note: If an outbreak of vaccine preventable illness occurs and your child has not received medical immunisation, your child will not be able to attend the centre during this time (normal fees and charges however will still apply).

Special medical conditions/requirements (Please tick if your child has any of the following):

Details for any selected conditions:

Please list any previous illnesses or operations (including infectious diseases):

Does your child require any specific cultural, religious, dietary or special care requirements?

Does your child have any behavioural difficulties we should know about?

Is your child toilet trained? YesNo

If Yes, toilet trained since:

Toileting support required? YesNo

More Details:

Please note, families must provide disposable nappies for children who are still wearing nappies.

Note: You may be required to complete an Emergency Health Management Plan for your child to ensure staff are appropriately equipped to manage your child's special health needs.

Consent Form

Please Note: All sections of this Consent Form must be completed to comply with the Education and Care National Regulations.

Medical:

In the event I am unable to be contacted, I give my permission for Kidz Galore to administer first aid, seek a registered medical, dental, hospital or ambulance service in the case of an emergency. I agree to pay any expenses incurred for medical treatment or transport.

Initial:

Health:

I give permission for health information regarding my child to be displayed at Kidz Galore (e.g., child's room and kitchen for allergy information).

Initial:

Allergy Disclaimer:

I give permission for Kidz Galore staff to give my child foods where the packaging states 'may contain traces of...' for the following allergens: eggs, dairy, peanuts, tree nuts, seafood, sesame, soy, fish, gluten. (With the exception of children with pre-existing allergies).

Initial:

Immunisation:

I certify that I have provided a true immunisation record for my child.

Initial:

Transport:

In the event of an emergency, I give my permission for Kidz Galore to transport my child as required as per regulations. Individual forms are completed for excursions and school transport.

Initial:

Excursions:

I give permission for my child to participate in short walking excursions from Kidz Galore (within 1km radius) and understand that excursions requiring vehicle travel will not occur without separate written authority.

Initial:

Observations:

I give permission for Kidz Galore staff and students to make documented observations of my child for programming purposes whilst in their care.

Initial:

Room Transitions:

I give permission for my child to be enrolled or transitioned into an age group that is up to 6 months higher or lower than their actual age based on my child's development as per regulation 123(7). I authorise my child to attend their care session in the room based on my child's development.

Initial:

Birthday Celebrations:

I give permission for my child to be involved in birthday celebrations including eating birthday cake prepared by our chefs.

Initial:

Ointments, Creams, and Applications:

I give permission for staff to apply the following if required:

SunscreenBand-AidsNappy cream

Initial:

Water Play:

I give permission for Kidz Galore to involve my child in any water play experiences provided while attending the centre.

Initial:

Religious/Cultural Celebrations:

I give permission for my child to participate in religious/cultural celebrations such as Christmas, Easter, Jewish celebrations, Chinese New Year, etc.

Initial:

Photography Permission

I give permission for Kidz Galore to take photographs of my child for the following purpose/s:

For my child's individual observations (learning journeys) included within my child's portfolio

YesNo

Initial:

Weekly Parent Newsletters

YesNo

Initial:

Publications and wall displays within my child's respective Kidz Galore centre

YesNo

Initial:

I am aware that my child's photographs may be displayed in other enrolled children's learning journeys/portfolios

YesNo

Initial:

Accounts, Fees & Charges

Please tick and initial that you understand and agree to the following in regards to your account, fees, and charges:

I give permission for Kidz Galore to send my account electronically via email to the email addresses provided and will inform the relevant centre of any changes to my primary contact email.

Yes

Initial:

I understand I must contact Centrelink to ensure I am registered for Childcare Subsidy (CCS).

Yes

Initial:

I am aware that Kidz Galore is under no obligation to apply CCS payments to accounts until they are received from Centrelink.

Yes

Initial:

I agree to pay the weekly fee on the due day as determined by the centre's payment requirements. Preferred method of payment is direct deposit set up by parents.

Yes

Initial:

I understand that normal fees are charged for Public Holidays and when my child is absent through illness, infectious disease or holidays and that no makeup days will be granted.

Yes

Initial:

I am aware that accounts are to be kept two (2) weeks in advance. Any failure to pay due fees may result in cancellation of care of my child at the centre.

Yes

Initial:

I understand that two (2) weeks written notice must be given prior to withdrawing my child's enrolment at Kidz Galore. Full fees may be charged in accordance with Centrelink guidelines for non-attendance during the notice period.

Yes

Initial:

I am aware that usual fees are payable for days where absences are taken (holidays, absent days, and sick days).

Yes

Initial:

I understand that a late collection fee of $20 per every 15 minutes will be charged if I am late to pick up my child from Kidz Galore.

Yes

Initial:

If my child is not collected by closing time and no contact is able to be made with the family, the Department of Child Protection will be contacted.

Yes

Initial:

I declare that the information in this enrolment form is true and correct and undertake to immediately inform the centre in the event of any change to this information.

Yes

Initial:

Direct Debit Agreement

Kidz Galore uses iPay as the preferred payment method. Fees are direct debited from your account or credit/debit card fortnightly. Please see iPay’s fee schedule below.

iPay Fee Schedule

iPay Fees
Bank Account (Per transaction)	$0.75
Visa / Mastercard (Calculated on transaction value)	1.56% + $0.75
Amex (Calculated on transaction value)	1.56% + $0.75
Failed Transaction (Per failed or returned transaction attempt)	$2.75

HUBHELLO CHILDCARE (for Credit Card or Debit Card debits) or HUBHELLO CCARE (for bank account debits) will appear as the transaction reference on the customer account statement. Note that all fees listed are excluding GST.

Bank Account Details:

BSB Account Number Account Name

Debit / Credit Card Details:

Card Number Expiry Name On Card

I, , have understood and agreed to the terms and conditions governing the debit arrangements between myself and Kidz Galore as set out in this Request and in my iPay Request Service Agreement.

An iPay registration record will be sent to the email address you have nominated on your child’s enrolment form.

Signed:

Date:

PANADOL Permission

In the event that your child becomes unwell, Kidz Galore requires verbal consent prior to administration of Panadol. This form is in place to ensure staff have written permission to administer Panadol to your child if verbal consent cannot be obtained.

As per regulation 93 of the Education and Care Services National Regulations 2012, Kidz Galore may contact a suitable registered medical practitioner or an emergency service to provide verbal consent for the administration of Panadol.

Child’s Name:

Medication:

Quantity to be administered:

Parent/Guardian Signature:

Date:

Registration & Conditions of Attendance Agreement

Please read the agreement and sign below:

I acknowledge having received and read the Parent Handbook and understand any changes will be displayed on the centre's notice board or will be informed via centre newsletters and communication.

I agree

I agree to comply with all Government requirements in relation to the centre and its services.

I agree

I am aware that Kidz Galore complies with the Government Priority of access guidelines being:

Priority 1 — a child at risk of serious abuse or neglect.
Priority 2 — a child of a single parent who satisfies, or of parents who both satisfy, the work, training, or study requirements.
Priority 3 — any other child.

Further information regarding these guidelines can be obtained from the DEEWR website.

I agree

I am aware that it is a legal requirement that I must sign my child in and out of the centre daily or full fees will be charged as per requirements from the FAO, and an additional fine may be issued.

I am aware that it is my responsibility to notify the centre manager in writing of any changes to my child's enrolment status (e.g., court orders, contacts, attendance, and collection details).

I agree

I am aware that my child cannot attend care sessions at Kidz Galore without all documentation provided and complete. I have provided a copy of my child's immunisation record and birth certificate and understand this is a Government regulation and must be provided before my child can start care.

I agree

I am aware of the fees policy and fee schedule (please see fee schedule displayed in your centre).

I agree

I am aware that care sessions are charged as a 12-hour flat rate, from 06:30 to 18:30.

I agree

I am aware that my child will be excluded from care at Kidz Galore if he/she has contracted a contagious disease or condition. I understand that a 'medical clearance certificate' from a medical practitioner is required before my child can return to care.

I agree

I understand that the Parents/Guardians/Authorised Contacts are responsible for their children in the car park and surrounding areas and that it is an offence to leave young children unattended in the car.

I agree

I have read this contract and received relevant information about the service offered by this centre for the care of my child.

I agree

Kidz Galore retains the right to cease care to any child or adult who displays behaviour which possesses a threat to other children, staff, or families at the centre.

I agree

Non-compliance with any part of Kidz Galore's policies and procedures may result in cancellation of care.

I agree

I, , completed this enrolment form and declare that the information provided is current.

I agree to the conditions of use of the Centre, its Handbook, and this Agreement.

I agree

1st Parent/Guardian Signature:

Date:

2nd Parent/Guardian Signature:

Date:

Prior to submitting this form, please ensure you have included the following:

Copy of child’s birth certificate

Child’s up-to-date Medicare immunisation record

Enrolment Form

Application Details

Child Details

Child’s Attendance Details (please tick the routine days you require)

Parent/Guardian One

Parent/Guardian Two

Additional Details

Family Arrangements & Custody Details

Emergency & Authorised Contact Persons

Authorised Person One

Authorised Person Two

Authorised Person Three

Authorised Contact Four

Each person listed above is an Authorised Person in respect of the authorities you have indicated.

Child's Medical & Health Information

Child’s Doctor and Contact Details

Please note: If an outbreak of vaccine preventable illness occurs and your child has not received medical immunisation, your child will not be able to attend the centre during this time (normal fees and charges however will still apply).

Special medical conditions/requirements (Please tick if your child has any of the following):

Consent Form

Medical:

Health:

Allergy Disclaimer:

Immunisation:

Transport:

Excursions:

Observations:

Room Transitions:

Birthday Celebrations:

Ointments, Creams, and Applications:

Water Play:

Religious/Cultural Celebrations:

Photography Permission

Accounts, Fees & Charges

Direct Debit Agreement

iPay Fee Schedule

Bank Account Details:

Debit / Credit Card Details:

PANADOL Permission

Registration & Conditions of Attendance Agreement

This enrolment form and supporting documents can be submitted in person or emailed to: kgcv@kidzgalore.com.au

Enrolment Form

Application Details

Child Details

Child’s Attendance Details (please tick the routine days you require)

Parent/Guardian One

Parent/Guardian Two

Additional Details

Family Arrangements & Custody Details

Emergency & Authorised Contact Persons

Authorised Person One

Authorised Person Two

Authorised Person Three

Authorised Contact Four

Each person listed above is an Authorised Person in respect of the authorities you have indicated.

Child's Medical & Health Information

Child’s Doctor and Contact Details

Please note: If an outbreak of vaccine preventable illness occurs and your child has not received medical immunisation, your child will not be able to attend the centre during this time (normal fees and charges however will still apply).

Special medical conditions/requirements (Please tick if your child has any of the following):

Consent Form

Medical:

Health:

Allergy Disclaimer:

Immunisation:

Transport:

Excursions:

Observations:

Room Transitions:

Birthday Celebrations:

Ointments, Creams, and Applications:

Water Play:

Religious/Cultural Celebrations:

Photography Permission

Accounts, Fees & Charges

Direct Debit Agreement

iPay Fee Schedule

Bank Account Details:

Debit / Credit Card Details:

PANADOL Permission

Registration & Conditions of Attendance Agreement

This enrolment form and supporting documents can be submitted in person or emailed to: kgcv@kidzgalore.com.au

Head Office