ASTI - A Step Towards Independence

Child's full name *

Child's Birthdate * +

Child's Gender *

Birth Certificate *

Child's Country of Birth *

Child's CRN Number *

Child's Medicare Number: *

Child's Language Spoken At Home *

Please Specify Other Language

Parent/Guardian #1 Full Name *

Parent/Guardian #1 CRN Number *

0/255 characters

Parent/Guardian #1: DOB * +

Parent/Guardian #1 Mobile: *

Parent/Guardian #1 email: *

Parent/Guardian #1 Address: *

Post Code *

Parent/Guardian #1 Place Of Work *

Parent/Guardian #2 Full Name

Parent/Guardian #2 CRN Number *

Parent/Guardian #2: Address

Post Code

Parent/Guardian #1 Phone Number *

Parent/Guardian #1 Place Of Work

Did you know that vaccinations are compulsory if your family want to receive the Government Rebate. If your child is not vaccinated, they pose too much of a risk to the other children at The Village Kids and will not be allowed to enrol (unless you have a medical certificate from your doctor stating the medical reasons why your child cannot be immunised). Please acknowledge you have read this by checking the box below. *

Yes, I acknowledge ASTI - A Step Towards Independence's vaccination policy

Are Your Child's Immunisations up-to-date? *

Yes

No

Please Upload Your Child's Immunisation Record Here

If Unable To Upload Form, Please Bring In A Hard Copy For The Director To Sight

Does the child have a diagnosed disability? *

Yes

No

Please upload any medical reports

If NOT diagnosed, please detail your concerns below

Has your child had any operations? *

Yes

No

If Yes, please let us know as much as possible here

Ethnicity *

Aboriginal/Torres Straight Islander

Caucasian

Other

Other Ethnicity (if not already listed)

Child's Religion (if none, please type "none" *

Type of Care Needed *

Childcare

Kindergarten

What Day/s Is Your Child Needing Care *

Reason for care required: *

Other Reason Your Child Is Needing Care: (If 'Other' has been selected)

Start Date * +

From time to time, State and Federal government; who fund this service, also seek information on the characteristics of families who use The Village Kids. This is used in planning new policies and resources to better the centre. To help provide accurate information, please answer the following question: Would extra assistance, such as; Occupational Therapy, Physio Therapy, Dietitian, be advantageous to your child's development? *

Yes

No

Would any of the following therapies be advantageous to your child's development?

Occupational Therapy

Physio Therapy

Dietician

Other

If other, which other service?

#1 Name of Authorised Person To Collect My Child (If I'm not available to) *

Relationship to child *

Phone Number *

#2 Name of Authorised Person To Collect My Child *

Relationship to child *

Phone Number *

#1 Emergency Contact's Name *

Emergency Contact's Number *

#2 Emergency Contact's Name *

Emergency Contact's Number *

IS THERE ANYONE NOT AUTHORISED TO COLLECT YOUR CHILD? *

Name Of Person NOT Authorised To Collect Your Child?

Are there any court orders relating to the powers and responsibilities of the parents in relation to your child? *

Original Court Order/s for Educators to see and keep for the duration your child is in care at ASTI - A Step Towards Independence.

Does your child see a regular doctor? *

Doctor's Name (Please put n/a if you want to leave this blank) *

Doctor's Phone Number *

Doctor's Address *

Child's Medicare Number *

Does you child have an allergies? *

Please check which allergies relate to your child

Please specify: Other

Does Your Child Suffer from Celiac Disease? *

Yes

No

If your child has Celiac Disease, we will cater to their dietary needs. Please acknowledge you have read this. *

Yes

No

A Service Support Plan will be developed during your child's orientation period (3 - 4 weeks) to ensure the needs of each individual child are able to be accommodated. Parents are required to be present during the child's orientation process to ensure that individual requirements of the child are identified and educators become familiar with any additional support required. Please acknowledge below that you have read this. *

Yes, I have read the information about the Service Support Plan.

If your child already has a current Support Plan, please upload it here

Has your child experienced 'day care' other than with the close family? *

Yes

No

If your child has any fears/phobias, please list them here. If none, please type "none" *

Who is claiming your child's CCS Government Rebate? *

How would you like your CCS to be paid? *

Directly to ASTI - A Step Towards Independence

To you first

Do you give permission for your child to participate in celebrations or events such as birthday, Christmas, Easter? *

Yes

No

I give permission for staff to apply 50+ sunscreen *

Yes

No

I give permission for staff to apply a band-aid when required *

Yes

No

I give permission for my child's photograph to be taken whilst in the care of The Village Kids. These photographs may be used for promotional purposes. *

Yes, I give my permission

No, I do not give my permission

I give permission for my child to participate in excursions from the Centre either by foot, bus or public transport, within the local community. *

Yes

No

I understand my child may appear in another child's group learning photos which may be sent home at the end of the year. *

Yes, I agree

No, I do not agree

I understand that the Policy documents are available to read at The Village Kids Centre. *

Yes

No

I have read The Village Kid's centre guidelines in the Family Information Booklet and agree to abide by them. *

Yes

No

I agree to notify The Village Kids if my child is absent from their enrolled care *

Yes

No

I give permission for staff to seek emergency medical, hospital or ambulance services for my child. *

Yes

No

If no, what do you want The Village Kids to do in the case of an emergency?

I agree to notify The Village Kids in the event of my child having an infectious illness (diagnosed by a medical practitioner) *

Yes

No

I accept that The Village Kids has a duty of care in the event of attending the centre under the influence of alcohol or drugs and that an alternative person is required to collect and/or transport my child. *

Yes

No

I agree to notify The Village Kids of any changes to my personal information *

Yes

No

I agree to pay (2) weeks in advance on my fees and charges and stay in advance throughout my child's entire enrolment at The Village Kids. *

Yes

No

I understand I must contact Centrelink to ensure I am registered to receive Child Care Subsidy (CCS). *

Yes

No, please explain this more to me

I understand that if I am late to collect my child at closing time, I will incur a fee of $5/minute *

Yes

No, please explain this more to me

I understand that all of the following is provided in my fee: (Please check boxes to acknowledge you have read them) *

All meals & snacks

All use of facilities

All excursions around the local area

All nappies/wipes for the babies room

**The children in the toddler room will need to provide their own nappies as there are too many different sizes to stock***

I understand that if late fees apply, they are not entitled to be incorporated into the CCS and that I have to pay these fees to The Village Kids as an extra charge. *

Yes

No, please explain this more to me

All fees at The Village Kids are individual to each child; depending on their CCS (Child Care Subsidy). These charges can be discussed with the Director at any time. The Director will then email you an enrolment letter which states the charges clearly. *

Yes, I understand

No, please explain this to me

Payment Of Security Bond: I understand that as per Centre Policy, I must pay $100 per child/$200 per family in care to be kept by The Village Kids as a Bond which will be refunded on notified departure of care providing that there is not an outstanding balance to my account. If there is a debt left on my account, I understand the centre will pass the details of my account on to the debt collection agency at the time and I will incur an extra 33% administration fee. **Two weeks' notice must be given prior to leaving the centre** *

Yes

No

I declare that the information provided on this enrolment form is current. I understand that all information regarding my child is confidential and will only be used for the care, education and assistance of my child. I understand that I am able to access a copy of information pertaining to my child at any time. *

Yes

No, please explain this more

Parent #1 Signature (Please use your mouse, finger or blunt object on the screen) *

clear

Parent #2 Signature (Please use your mouse, finger or blunt object on the screen)

clear

How satisfied were you using this online enrolment form? *

Please ask us about something else here

Email This Form To *

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