Enrolment E-Form Forbes Preschool Enrolment form Child's Name* First Last Other name known asSex*FemaleMaleDate of birth*Birth CertificatePlease attach or present to the preschool a Birth CertificateHome Address* Street Address City State Post code Home phoneMobileNationalityHome languageChild’s Place of BirthIs your child of Aboriginal or Torres Strait Islander descent?YesNoReligious and cultural background and any practice/s you consider should be observed at the preschool in respect of the child’s religious/cultural backgroundSpecial requirements concerning your child (such as requirements relating to your child’s culture/religion or to any needs in relation to any disability)Details of any Dietary RestrictionsIf your child suffers from Anaphylaxis or Allergy from food you are required to provide preschool with an Action Plan and medication form before commencement. Details of these forms can be received from our staff, you will be sent an email with details.Days of attendance as confirmed by the Preschool Monday Tuesday Wednesday Thursday Friday School detailsWhich Primary School will your child be attending?What year will your child be going to school (kindergarten)?Caregiver 1Name* First Last Other names known by (if any)Address As above Home Address (If different) Street Address City State Post code Home phoneMobileEmail OccupationWorkplaceWork phoneWork statusFull timePart timeCasualDo you have any skills or expertise you could share with us:Caregiver 2Name First Last Other names known by (if any)Address As above Home Address (if different) Street Address City State Post code Home phoneMobileEmail OccupationWorkplaceWork phoneWork statusFull timePart timeCasualDo you have any skills or expertise you could share with us:Court ordersAre there any court orders, parenting orders or parenting plans affecting your child?NoYesDetailsPlease attach or provide to Preschool before commencement. Is there any other relevant information?AuthorisationNote: You must have a minimum of 2 additional contacts. The following people are authorised by me to be contacted in an emergency or to collect my child from Forbes Preschool. I understand that the staff will only release my child to the people listed below. The following people are also authorised to consent to medical treatment of, or to authorise administration of medication, and authorised to authorise an educator to take my child outside the Preschool. 1. Name* First Last Address Street Address City Home phoneWork PhoneMobile2. Name* First Last Address Street Address City Home phoneWork PhoneMobile3. Name First Last Address Street Address City Home phoneWork PhoneMobileOther Children in FamilyNameDate of birthNameDate of birthNameDate of birthNameDate of birthNameDate of birthOther Adults Living In the HomeNames of other adults living in the home eg: grandparent, boarder etc (if applicable)Medical HistoryChilds Preferred Doctor First Last Phone numberAddress Street Address City Childs Preferred Dentist First Last Phone numberAddress Street Address City Childhood illnesses and or accidentsDoes your child have any allergies/have they been diagnosed at risk of anaphylaxis?Does your child have any epilepsy or any other medical condition (please provide details)?Has your child ever had asthma?NoYesAction PlanYou must provide an Action Plan from a medical professional. Please attach it here or provide to Preschool before commencement.Is your child's immunisation up to date? (Please upload statement or present to the Preschool)?*NoYesImmunisation RecordDoes your child see a speech therapist, occupational therapist or other health professional?*NoYesDoes your child have a NDIS plan?*NoYesPlease provide numberAdditional NeedsMedication required (if applicable)Medicare Number*Subsidy InformationAre you eligible for subsidy assistance?Note: In order to receive subsidy you MUST prove you are eligible with either Health Care Card or Pension Card or identify as Aboriginal or Torres Strait Islander. YesNoPlease attachAre you an incorporated member of the Preschool?i.e. Have you had a previous child attend Forbes Preschool?YesNoAdditional informationHow did you find out about Forbes Preschool?Has/does your child previously attended a childcare service and or a Preschool?YesNoWhich childcare and or preschool has/does your child attend?What would you like to see your child gain from attending Forbes Preschool?Is there anything else you feel is important to tell us?AgreementsMedical permission*I give permission for the Forbes Preschool Kindergarten staff to seek urgent medical, dental or hospital treatment or ambulance service in the event that my child becomes ill or is injured at the premises, and consent to the carrying out of appropriate, medical, hospital, or dental treatment. I agree to take responsibility for any fees resulting from such treatment.YesFee Payment*I agree to pay the required fees regularly, with the balance of my account finalised before the end of term.YesCollection of child*I will notify the Preschool in writing should I wish my child to be collected by any other person than those stated. YesAttendance*I agree to notify the Preschool two weeks in advance of any change to my child’s attendance or termination.YesObservations*I give permission for my child to be observed for programming and educational purposes. YesCultural programming*I give permission for my child to participate in programmed cultural activities that incorporate the variety of cultures represented in our community. YesRoutine Excursions*I give permission for my child to participate in local walking excursions.YesNoSchool Information*I give permission for the Preschool to provide the school which my child will be attending the following year with educational feedback on my child. YesNoSunscreen/insect repellent*I give permission for staff to apply sunscreen and insect repellent to my child.YesNoAdditional Program/s*I give permission for my child to attend additional programs run in the preschool including Occupational Therapy, Speech Therapy, Cultural programmingYesPhotographing children*I give permission for my child to be photographed for the following reasons: (Please tick all that apply) Educational purposes/ Preschool programming Publicity/media Terms & ConditionsResponsibility for children travelling to and from the Preschool is accepted by the parents. It is the responsibility of the parents to take their children to a staff member upon arrival. Parents are responsible for making arrangements concerning children travelling by bus, with the bus company concerned. Please notify the Preschool as soon as possible if your child will be absent. If due to sickness, please state the nature of the illness, especially if an infectious disease. A child absent for three or more consecutive weeks without due cause and notification may forfeit their position at Preschool.I understand and agree to abide by the terms and conditions stated*YesCONSENT TO USE AND DISCLOSURE OF CHILD’S PERSONAL INFORMATION[NB: Each parent or legal guardian must sign and return a copy of this form.] I understand that Forbes Preschool Kindergarten will collect my child or legal ward’s (as identified below) (Child) personal information. Personal information (including information or an opinion) may include information that I provide (or someone provides on my behalf) as part of my Child’s enrolment application or as part of an application for funding for my Child or otherwise in connection with the child’s attendance at the Preschool, including the child’s name, date of birth, and sensitive information such as information relating to the Child’s health including any disability (this may include medical records and reports) (Personal Information). I authorise the Service to disclose my Child’s Personal Information to the New South Wales Department of Education and Communities (Department). I understand that the Department will only use or disclose such Personal Information relating to the Child as permitted under applicable privacy laws including the Privacy and Personal Information Protection Act 1998 (NSW). In limited circumstances this may include disclosure to other Australian government agencies, including the Commonwealth and to those located in States and Territories outside New South Wales. The Department may use my Child’s Personal Information for any purpose relating to the exercise of its governmental functions including for, but not limited to, the assessment and potential provision of support or funding to my child or the Service including for any teachers or caregivers in connection with the Service. If you do not agree to your Child’s Personal Information being provided to the Department then this could impact the funding allocation made available to the Service. Under law, you may have a right of access to, and correction of, such Personal Information. Please contact the Service or the Department in such circumstances.Full Name of Child* First Last Date of Birth* Date Format: MM slash DD slash YYYY Full Name of Parent/ Legal Guardian* First Last Relationship to Child (e.g. mother, father, guardian)*Today's Date* Date Format: DD slash MM slash YYYY Give consent*I consent to the collection, use and disclosure of my Child’s Personal Information in the manner outlined in this form. YesWould you like to sign up to our newsletter?*YesNoEmail AddressEnter the email you'd like the newsletter sent to. You will receive a confirmation email to opt-in.