BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018 Name of Parent Claiming CCB: Child/ren’s name/s: Have you used Sutherland Shire Council’s Vacation Care before? Yes No TERMS & CONDITIONS Fee Payments . In applying for enrolment, I hereby acknowledge that I am wholly responsible for all fees payable to Sutherland Shire Council, in respect to my child/ren being in care. . I understand that any fees paid are not refundable or transferable. . I am aware that bookings are subject to availability and the early bird rate will not apply after the enrolment closing date. Please Refer to the current Schedule of Fees & Charges on the Council’s Website. . I am aware that I am required to complete either my credit card details or direct debit details on the attached form. . I am aware that I am liable to pay for the days and excursions requested on this form (subject to availability) and I cannot cancel or request an exchange of days. . I am aware that I can add days and make payment at that time Child Care Benefit & Child Care Rebate . Any request for a CCB backdate can only be done up to 30 days from the end of the Vacation Care period. . I understand that I am responsible for registering for Child Care Benefit and Child Care Rebate. . I acknowledge that if there is no Child Care Benefit or Child Care Rebate approval at the time of my booking I am liable to pay full fees. Injury or Loss to Person or Personal Property . I understand that whilst every care and precaution will be taken, Sutherland Council and its staff are not responsible for any injury, damage or loss to my child or their possessions whilst at the Centre or on an excursion. Privacy And Storage Of Information The personal information that Council is collecting from you is for the purposes of the Privacy and Personal Information Protection Act 1998 (“the Act”). The information you have supplied will be stored at Council while your child is attending care and electronically for Child Care Benefit purposes. This information will then be stored in Council archives for up to 7 years. The intended recipients of the personal information are: . Authorised Officers within Sutherland Shire Council . A person otherwise authorised by law to inspect the records. Council is collecting this information for the purpose of maintaining accurate child-care information and parental contact details. In addition, Council may use this information for time to time in order to contact you to inform you of updated children’s services information. OFFICE USE ONLY File Name: Entered By: Family Code: F0 Date Entered: Receipt: Journal:
This page is to be returned to Children’s Services P a g e 1 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018 TERMS & CONDITIONS CONTINUED Booking Conditions . Payment will be processed or charged by close of business the day your booking is received . Attendance will be refused if parent arrives at service without making payment prior . Bookings received after the closing date will be charged the daily fee rate . If your enrolment form is not completed your booking will not be processed until a completed enrolment form is received. . The enrolment/booking form for the current vacation care period must be completed. Copies of previous forms will not be accepted . Booking will not be accepted after 10:00am the day before care Information For Parents If Your Child Does Not Attend Care On The Scheduled Start Date Families who give notice of their intention to not start care on the agreed date need to be aware of the following information provided in the Child Care Service Handbook 2014, Section 13. In particular we draw your attention to the area of Child Care Benefit (CCB) and Child Care Rebate (CCR) which may not be payable to families. The following is an extract from the abovementioned Handbook containing information that is relevant to this service: “A child who has not yet received care … CCB will not be paid for absences where fees are charged to reserve a place for a child who has not yet started education and care. CCB will not be paid for absences once a child has ceased education and care. However, if a child is booked in to start at your service on a particular date, and does not start on that day the family may only receive CCB for the days the child was expected to attend if the child's 42 days absences have been exhausted and the absence is an additional absence. Initial 42 days absences may not be claimed for these days". Please be aware that Sutherland Shire Council observes the above practice and that in the event your child does not start care on the booked date, CCB is not payable on the outstanding amount. If you require further clarification of this, please call the Customer Service Team on 9710 0466. Excursions & Transport . I understand that excursions may be cancelled due to low numbers and I will be credited back the excursion cost . I understand that due to numbers and staffing my child may be transported to and from another centre if they are not attending an excursion, and I will be notified of this at the centre.
Has your child been immunised in accordance with Department of health guidelines?
Please supply an updated immunisation statement if your child falls into one of the following categories: . Child is new to the service . Child has been immunised since last supplied immunisation statement I have agreed to enrol my child/ren in the Sutherland Council Vacation Care Program. (Names of children) I have read and agree to be bound by the abovementioned Terms and Conditions
Print Name: Date:
Email Address: Relationship to child/ren:
This page is to be returned to Children’s Services P a g e 2 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018 You must complete all the sections below: PARENT / GUARDIAN 1 (Parent / Guardian Claiming CCB)
Relationship to Child/ren First Name Surname Home Phone No Work Phone No Mobile Phone No Date of Birth Address Occupation Country of Birth Parent’s CRN PARENT / GUARDIAN 2
Relationship to Child/ren First Name Surname Home Phone No Work Phone No Mobile Phone No Date of Birth Address Occupation Country of Birth
Medicare Number: EMERGENCY CONTACTS - If parents unavailable Emergency Contact Contact 1 Contact 2 First Name Surname Home Phone No Work Phone No Mobile Phone No Relationship To Child Please tick which permissions you give each contact person To collect child/ren To collect child/ren To authorise medication for child To authorise medication for child To authorise excursions for child To authorise excursions for child
This page is to be returned to Children’s Services P a g e 3 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018 CULTURAL BACKGROUND
What is the primary language used in your child/ren’s home?
What is the cultural background of your child/ren?
What is the cultural background of you and your partner?
Are there any religious or cultural requirements relating to your child/ren's upbringing that you would like us to honour in caring for your child/ren?
Are you or any of the children listed on this form Aboriginal or Torres Strait Islander background? Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander Neither Unknown Decline to advise
WHERE DID YOU HEAR ABOUT THIS SERVICE? Our Shire Internet Have Used Before Word Of Mouth School Newsletter Library Other (Please Specify)
REASON CARE REQUIRED (X ONE only) At Risk / Referral (e.g. DoCS Referred) Working / Studying / Maternity Leave / Returning to work / Looking for Work Respite Care - Not Working and Not Looking for Work
Are there any Court Orders or Custody Arrangements Relating to your Child/ren?
If Yes a certified copy needs to be supplied prior to the start of care
This page is to be returned to Children’s Services P a g e 4 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018
Child 1 Child 2 First Name Surname Date Of Birth Gender Child’s School Country of Birth Child’s CRN
Allergies#
Special Needs
Medical Conditions*
Child 3 Child 4 First Name Surname Date Of Birth Gender Child’s School Country of Birth Child’s CRN
Allergies#
Special Needs
Medical Conditions*
* If your child has a medical condition, you will be required to provide a current medical management plan at the time of enrolling. Bookings will not be accepted until this documentation is provided. Plans will need to be updated annually from the date on the medical documentation or as changes occur to the child's condition for children returning to care and resubmitted. # If your child has an allergy that requires medication if exposed you will be required to complete the Medical Management Plan
This page is to be returned to Children’s Services P a g e 5 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018
AUTHORISATIONS
Products . Thermo Accident Blanket . Adhesive Dressing Tape . Sterile Wound Dressing . Safety Pins - Assorted . Plastic Bag For Amputation . First Aid Guide Forehead . Scissors - Sharp/Blunt Splinter Thermometer . Non-Adhesive Dressing Pad Forceps . Rapaid First Aid Spray . Sterile Eye Pad . Sterile Eyewash . Rapaid Itch Relief Sachet . Conforming Gauze Bandage . Antiseptic Swabs . Disposable Resuscitation Face . Conforming Gauze Bandage . Triangular Bandage Shield . Disposable Latex Gloves . Band-Aids/Elastoplasts . First Aid Tool Box (11090)
Authorisation Details Active: - Octyl Methoxycinamate 60mg/g - Butyl Methoxydibenzoylmethane 20mg/g Cancer Council Sunscreen 30+ Other: - Phenoxyethanol 3mg/g - Hydroxybenzoate 4mg/g - Methylbenzylidene Camphor 30mg/g Active: - 160b LN, N-diethyl m Tuoluamide (DEET) - 20g/1 N-Octyl Dicycloheptene Dicarboximide Rid Cream Repellent - 10g/1 Di-N-Propylisocinchomeronate - 1g/1 Tricolsan - 5ml contains 120 mg paracetamol Panadol Colour-Free - Free from asprin, sugar and alcohol Ventolin - (in the event of a suspect Asthma - 100mg Salbutamol Attack) - HFA - 134a propellant Use Photography & Video For developmental, educational, publication or communication, purposes at the Centre Use For TAFE and / or University Students to observe and document information about my child Student Documentation for the purpose of Early Childhood Studies. I am aware that all documentation will remain confidential and only first names will be used.
I give permission for all of the above items to be used on my child/ren Children’s Names: I give permission for the above items to be used on my child/ren EXCEPT the items listed below Child’s Name Items to not be used
Initial PERMISSION FOR MEDICAL TREATMENT & AMBULANCE SERVICE Yes No I authorise staff at the service to seek emergency treatment for my child from a registered medical practitioner including medical, hospital, dental and ambulance service (including ambulance transportation) should this be considered necessary.
Completed By: Date:
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Signature: Date:
Monday 18th December 2017- Thursday 25th January 2018 Please complete the sections below:
BOOKING OF DAY/S: (Please cross in the appropriate box the days you require) Denotes Compulsory excursion/activity days Denotes Optional excursion/activity days WEEK 1
CHILDS AGE Monday Tuesday Wednesday Thursday Friday NAME 18th 19th 20th 21st 22nd December December December December December 1) 2) CENTRE CENTRE 3) CLOSED CLOSED 4)
Excursion Week 1 Description No. Children Total Payable Fee Clay Christmas Tree Lanterns Compulsory Wednesday In House 20/12/17 Activity X $16.00 = $ Total Fee for Excursion s Week 1 = $ Yes No If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre You will be advised if any excursions/incursions are unavailable
WEEK 2
Centre Closed Monday 25th December 2017 - Friday 29th December 2017
** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date ** ** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date **
This page is to be returned to Children’s Services P a g e 7 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018 Early Bird closing date is Sunday 10th December 2017 at Midnight.
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BOOKING OF DAY/S: (Please cross in the appropriate box the days you require) Denotes Compulsory excursion/activity days Denotes Optional excursion/activity days WEEK 3
CHILDS AGE Monday Tuesday Wednesday Thursday Friday NAME 1st January 2nd January 3rd January 4th January 5th January 1) 2) CENTRE 3) CLOSED 4)
Excursion Week 3 Description No. Children Total Payable Fee Movie @ Miranda “Ferdinand” Optional 10- Wednesday 12yr old 03/01/18 Excursion X $25.00 = $ Hands on Science Fun Compulsory Thursday all ages 04/01/18 incursion X $10.00 = $ Total Fee for Excursion s Week 3 = $ Yes No If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre You will be advised if any excursions/incursions are unavailable ** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date ** ** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date ** Early Bird closing date is Sunday 10th December 2017 at Midnight.
This page is to be returned to Children’s Services P a g e 9 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018
BOOKING OF DAY/S: (Please cross in the appropriate box the days you require) Denotes Compulsory excursion/activity days Denotes Optional excursion/activity days WEEK 4
CHILDS AGE Monday Tuesday Wednesday Thursday Friday NAME 8th January 9th January 10th January 11th January 12th January 1) 2) 3) 4)
Excursion Week 4 Description No. Children Total Payable Fee Picnic & Swim @ Shelly Beach Optional 10- Tuesday 12yr old 09/01/18 excursion X $14.00 = $ Sky Zone Miranda Optional all Wednesday ages 10/01/18 excursion X $37.00 = $ Splashtasti c Water Games Compulsory Thursday In House 11/01/18 Activity X $16.00 = $ Total Fee for Excursion s Week 4 = $ Yes No If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre You will be advised if any excursions/incursions are unavailable ** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date ** ** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date ** Early Bird closing date is Sunday 10th December 2017 at Midnight.
This page is to be returned to Children’s Services P a g e 10 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018
BOOKING OF DAY/S: (Please cross in the appropriate box the days you require) Denotes Compulsory excursion/activity days Denotes Optional excursion/activity days WEEK 5
CHILDS AGE Monday Tuesday Wednesday Thursday Friday NAME 15th January 16th January 17th January 18th January 19th January 1) 2) 3) 4)
Excursion Week 5 Description No. Children Total Payable Fee Colour Wars Compulsory Tuesday In House 16/01/18 Activity X $16.00 = $ Yoga @ the centre Optional all Thursday ages 18/01/18 incursion X $10.00 = $ BMX Bikes @ Homebush Optional 10- Thursday 12yr old 18/01/18 excursion X $35.00 = $ Sutherland Leisure Centre Optional all Friday ages 19/01/18 excursion X $32.00 = $ Total Fee for Excursion s Week 5 = $ Yes No If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre You will be advised if any excursions/incursions are unavailable ** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date ** ** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date ** Early Bird closing date is Sunday 10th December 2017 at Midnight.
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This page is to be returned to Children’s Services P a g e 12 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018
BOOKING OF DAY/S: (Please cross in the appropriate box the days you require) Denotes Compulsory excursion/activity days Denotes Optional excursion/activity days WEEK 6
CHILDS AGE Monday Tuesday Wednesday Thursday Friday NAME 22nd January 23rd January 24th January 25th January 26th January 1) 2) CENTRE 3) CLOSED 4)
Excursion Week 6 Description No. Children Total Payable Fee Kids Kitchen Class Compulsory Monday all ages 22/01/18 incursion X $16.00 = $ Water Fun @ Woronora Optional 10- Monday 12yr old 22/01/18 excursion X $28.00 = $ Miranda Movies “Paddingto n 2” Optional Tuesday all ages 23/01/18 excursion X $32.00 = $ Canvas Bags @ the Centre Compulsory Wednesday In House 24/01/18 Activity X $12.00 = $ Total Fee for Excursion s Week 6 = $ Yes No If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre You will be advised if any excursions/incursions are unavailable ** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date ** ** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date ** Early Bird closing date is Sunday 10th December 2017 at Midnight.
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EXCURSION PERMISSIONS Children’s Names: I give permission for my child/ren (mentioned above) to participate in the following excursion/s: to Miranda Movies on Wednesday 3rd January 2018. The activities will include watching a movie, walking through the shopping Centre and eating lunch in Miranda Westfield’s. I understand they will be travelling by bus or walking from MOOSH and will be away from the service for approximately 7 hours. to Shelly Beach for a picnic & swim on Tuesday 9th January 2018. The activities will include swimming at the beach, playing on the sand, having a picnic and buying food from the local shops. I understand they will be travelling by bus and will be away from the service for approximately 7 hours. to Sky Zone at Miranda on Wednesday 10th January 2018. The activities will include jumping on the trampolines at Sky Zone and climbing on the equipment. I understand they will be travelling by bus or walking from MOOSH and will be away from the service for approximately 5 hours. to BMX bike riding at Sydney Olympic Park on Thursday 18th January 2018. The activities will include BMX bike riding on the BMX bike tracks and eating lunch. I understand they will be travelling by bus and will be away from the service for approximately 7 hours. to Swimming at Sutherland Leisure Centre on Friday 19th January 2018. The activities will include swimming in the indoor and outdoor pools, going down the water slide and eating. Children need to be able to swim independently. I understand they will be travelling by bus and will be away from the service for approximately 7 hours. to Water Fun at Woronora on Monday 22nd January 2018. The activities will include canoeing, paddle boarding, ball games and a picnic in the park. I understand they will be travelling by bus and will be away from the service for approximately 7 hours. to Miranda Movies on Tuesday 23rd January 2018. The activities will include watching a movie, walking through the shopping Centre and eating a snack from the cinema. I understand they will be travelling by bus or walking from MOOSH
This page is to be returned to Children’s Services P a g e 14 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018 and will be away from the service for approximately 5 hours.
A risk assessment has been finalised for all excursions and is available. There will be a 1:8 ratio on the excursion. I understand and agree that whilst every care will be taken, Sutherland Shire Council and its Staff will not be liable for injury or loss to my child/ren or their belongings. Date Parent Name: :
Completed By: PLEASE NOTE: The excursions must also be included on the booking sheets.
This page is to be returned to Children’s Services P a g e 15 BURRANEER BAY ENROLMENT FORM DECEMBER 2017 / JANUARY 2018 PAYMENT METHODS CREDIT CARD - a merchant fee is applicable on all credit card payments - See details below
Cardholder’s Name:
Card Type: Visa MasterCard American Express
Card No:
Expiry Date: / Payments will automatically be deducted and an email sent advising the amount to be deducted
DIRECT DEBIT - this option is only available in advance of care date Please use my existing Direct Debit set up for Vacation Care
Please use set up a Direct Debit for Vacation Care using the details below
Financial Institution:
Branch:
Name on account:
BSB Number:
Account Number: Note - Name of account is not the type of account, i.e. Savings, Home loan; it is the name the account is under, i.e. Mr John Citizen, Mrs J. D. Citizen. Payments will automatically be deducted and an email sent advising the amount to be deducted Direct Debit Conditions
I understand that if my Direct Debit is dishonoured by the above Institution, I will incur a fee. (see current Schedule of Fees & Charges) I understand if my account details change I must inform Sutherland Shire Council Children’s Services in writing.
Completed By: Date:
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