Child Care Service

Vacation Care Postal Address: PO Box 468, Annerley 4103 Phone: 3363 2200 Fax: 3392 6249 ABN: 28 728 322 186 Email: [email protected]

www.uccommunity.org.au

Client Booking Form

Please return this form and all other relevant documents back to Lifeline Vacation Care by Friday 23rd of May 2014. Bookings received after this date will be subject to staff availability. All information fields must be completed for your booking to be processed. Please note that there are limited places available and places will be allocated in line with Priority of Access guidelines as stated in the Vacation Care- Parent Handbook.

Section 1 – Child Details (Children to attend service) Child #1 Name Medication on program Gastrostomy Feed Allergies Epilepsy Yes No Yes No Yes No Yes No Child #2 Name Medication on program Gastrostomy Feed Allergies Epilepsy Yes No Yes No Yes No Yes No

Section 2 – Contact Details

Parents Name Postal Address (if changed) Post Code Email Address Home Phone Work Phone Mobile Emergency Contact – To be contacted if parent is unable to be reached Name Relationship Home Phone Work Phone Mobile

Section 3 – Payment Options

Invoices to be sent to Parent/Carer Support organisation If a support organisation is to be invoiced for fees, the person responsible for payment/contact person must fill in the follow section confirming payment, before this booking can be formalised. No booking can be made without organisation approval. Organisation Name Attention to Contact Phone Number Postal Address Email Address Section 4 – Administration The following information needs to be accurate and up to date to correctly calculate your Child Care Benefit and Fee Reduction.

Do you have any other children in care? Yes No If yes, how many?

Section 5 – Booking Options

Vacation Care Postal Address: PO Box 468, Annerley 4103 Phone: 3363 2200 Fax: 3392 6249 ABN: 28 728 322 186 Email: [email protected]

Due to increasing demands for placements this Vacation Care, Staff Availability and following the priority of

Please indicate preferred service Beenleigh Mt Gravatt Mitchelton Mt Ommaney Booking Dates Monday Tuesday Wednesday Thursday Friday 30th June 1st July 2nd July 3rd July 4th July 7th July 8th July 9th July 10th July 11th July

access, you may not receive all of the days requested.

Please be aware that you will be placed on a waiting list for any last minute cancellations.

2 Inclusion Support Form last revised 20.08.10 Vacation Care Postal Address: PO Box 468, Annerley 4103 Phone: 3363 2200 Fax: 3392 6249 ABN: 28 728 322 186 Email: [email protected]

Section 6 – Terms and Conditions

I agree to all terms and conditions for my child to attend UnitingCare Community Vacation Care and understand that Vacation Care will do their best to meet my requested booking needs.

My child will have all their personal requirements with them each day including: Morning/Afternoon Tea, Lunch, minimum 2 changes of clothes, hat, any personal care item eg. nappies, medications and medical procedure equipment (if applicable). UnitingCare Community Vacation Care is Allergy Aware and requires your assistance to be Nut Free, please consider the many clients at Vacation Care whom have severe allergic reactions to nuts. All personal property will be labelled with my child’s name (including toys, shoes and jumpers) and I will not hold Vacation Care responsible for lost items. I agree to pick my child up by the time the centre closes at 5pm and am aware that a $2 a minute late fee applies if do not without contacting the centre (please see Late Fee section of Parent Handbook). I am aware of my responsibly to collect my child if an unsafe situation arises, my child is ill or injured or my childs behaviour has become unsafe and more assistance is required than staff ratios allow. I am aware that cancellations or date changes can be made up to one week out from the first day of Vacation Care and any after that date will incur a cancellation fee of $20 per day. Any date change will also incur the cancellation fee and a new booking date will depend on staff availability.

I will notify Vacation Care if my child will be absent from the program and understand that I will be charged the full fee for all bookings confirmed.

I will notify the Administration Team on 3363 2200 (ask for Vacation Care) of any changes to my child’s health care needs as they arise. I understand that I am responsible for the payment of my Vacation Care account within fourteen days of invoice issued. Signature of Parent/Carer Date Name (please print full name)

3 Inclusion Support Form last revised 20.08.10