Application for Enrolment
Child’s Given
Name/s
.............................................................................................................................................................
Child’s Family
Name
.............................................................................................................................................................
Gender........................... D.O.B…………………………..Age………………………….Will you be claiming Child Care Benefit? YES / NO
Address ........................................................................................................... Suburb .........................................................................PC ..........................
Email ...................................................................................... Phone
..............................................................................................
Bill Fees to  Mother  Father  Other ................................ Place of Birth
..............................................................................................
Religion .................................................. Primary
Language ...............................................
Cultural Background ................................ Legal
Guardian ................................................
How many allowable absences have you used this financial year (i.e. 1/7 –
30/6)
.............................................................................................................................................................
(Please staple evidence to the last enrolment page to support this)
Name and details of anyone who is prohibited from having contact with or collecting your child
.............................................................................................................................................................
.............................................................................................................................................................
Court
order
sighted
&
copied
by
Director
.............................................................................................................................................................
(Please provide a photo of the above mentioned to help staff identify them)
Do you have a sibling or have had a child previously enrolled at this centre?
If YES, child’s
name
.............................................................................................................................................................
PLEASE TICK IF ADDRESS AND PHONE NUMBER IS SAME AS CHILD’S 
Driver’s Licence Number:………………………………………………………….
Mothers/Guardian Given Name/s ................................ Mothers/Guardian Family
Name
Maiden name and/or other aliases (if applicable)
…………………………………………………………………………………………..
Address ........................................................................................................... Suburb .........................................................................PC ..........................
Phone................................................................. Mobile
..........................................................................
Relationship to Child ............................................ Primary Language and
Nationality ..........................................................
 Married  De facto  Widowed  Single  Separated  Divorced
Mothers/Guardian work details
Employer……………………………………..Address of Employer……………………………….
Phone............................................ Casual

Full-time

Part-time
Occupation ....................................
PLEASE TICK IF ADDRESS AND PHONE NUMBER IS SAME AS CHILD’S  Driver’s Licence Number: ......................................................
Fathers/Guardian Given Name/s ................................. Fathers/Guardian Family
Name
Other aliases (if applicable)…………………………………………………………………………………………………………………………...
Address ........................................................................................................... Suburb .........................................................................PC ..........................
Phone................................................................. Mobile
..........................................................................
Relationship to Child ............................................ Primary
Language ...........................................................
 Married  De facto  Widowed  Single  Separated  Divorced
Fathers/Guardian work details
Employer……………………………………..Address of Employer………………………………….
Phone............................................ Casual

Full-time

Part-time
Occupation ....................................
.....................................................
ATTENDANCE
Time Req’d
MONDAY
ROOM
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
AM-PM
0-2 yrs Old
__am to__pm
2-3 Yrs Old
__am to__pm
3-6 Yrs Old
__am to__pm
(Please tick the days required. NOTE: Only one service type can be selected)
CHILD HEALTH INFORMATION
Has your child been assessed / or do you wish to have your child assessed for any additional needs. (NB if
your child has been assessed in the following areas please provide documentation in relation to the
assessment) e.g.
 Asthma
 Gifted/Talented
 Anaphylaxis / or other food allergies
 A.D.D /A.D.H.D
 Speech
 Behavioural Conditions

Other
.............................................................................................................................................................
Has
your
child
ever
experienced
any
language
or
speech
difficulties?...........................................................................
Has
your
child
any
Current
Medical
Treatment?
.............................................................................................................................................................
Does your child have any proven
allergies?
.............................................................................................................................................................
Does your child have any special dietary requirement - food & products not allowed ....................................
Has your child had:
 Measles
 Mumps
 German Measles
 Chicken Pox
 Ear Infection
 Throat Infection
 Throat Infection
 Hepatitis
Children enrolling in child care must provide continuing proof of current immunisation status. Failure to provide this proof will
mean that your child will not be able to attend the centre should there be an outbreak of a vaccine-preventable disease – and fees
will be charged during this period.
Has your child been immunised?
YES/ PARTIALLY/ NO
Please ensure a copy is issued to our Authorised
Supervisor.
Medicare Number……………………………………………Health Fund……………………………………Health Fund
Number………………..
Does your child have any great fears?
............................................................................... ……………………………………………………………………………
……
Please state any religious or cultural requirements we need to abide by whilst caring for your
child
.............................................................................................................................................................
.............................................................................................................................................................
Is your child toilet trained? YES / NO
.............................................................................................................................................................
(NOTE If your child is 3 years + they must be fully toilet trained to attend Preschool)
Special words your child uses when wanting to use the
toilet
.............................................................................................................................................................
.............................................................................................................................................................
Does your child sleep in the daytime? YES / NO
Does your child need a security toy/item to sleep with?
.............................................................................................................................................................
Does your child celebrate Christmas? YES / NO
Does your child celebrate Easter? YES / NO
Does your child celebrate Birthdays? YES / NO
How may we best help your child this year?
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
……………..
What information do you consider is important to know upon collection of your child each day, and what is
the best means of conveying this to you?
...............................................................................................................................................................
...............................................................................................................................................................
................................
Do you wish your child to participate in non-denominational scripture lessons? YES / NO
Would you like all written correspondence in English? YES / NO If No, give
details
.............................................................................................................................................................
EMERGENCY DETAILS
Please attach any court orders pertaining to your child and give any additional information. The Authorised Supervisor must sight original legal
documentation before photocopying them to add to your child’s file. A photograph of any unauthorised persons is required to aid staff in prompt
identification of improper persons.
Please be aware that we are legally mandated to report any suspicion of Risk of Harm that may be apparent to any attending child and their family
members.
Family Doctor .................................................................. Telephone
Number ..........................................................................
Address ........................................................................................................... Suburb .........................................................................PC ..........................
Has your child ever been in Hospital? YES / NO If Yes, Give length of stay and
reason
.............................................................................................................................................................
.............................................................................................................................................................
Has your child any known medical
conditions?
.............................................................................................................................................................
Do you give the centre Authority to call an Ambulance YES /
NO
Religious requirements in case of an
accident
.............................................................................................................................................................
Family Dentist……………………………………………………………………….Telephone
Number………………………………………………….
Address…………………………………………………………………………..Suburb……………………………………………….… Post
Code………………….
EMERGENCY CONTACTS
The following information is very important please think carefully before completing. These are person’s other than the child’s
parents/guardian that are permitted to drop off and collect your child.
NOTE Persons you list below must be over the age of 18.
Given Name/s ..................................................... Family
Name ...................................................................
Relationship to Child .................................... Home
Phone.........................................................
Work
Phone......................................................... Mobile
..................................................................
Address .............................................................................................. Suburb ......................................................................................PC ..........................
Emergency Release YES/NO
Daily Pick Up YES/NO
(Telephone authorisations for child collection cannot be accepted)
Consent to Medical Treatment YES/NO
Authorise to Administer Medication
Given Name/s ..................................................... Family
Name ...................................................................
Relationship to Child .................................... Home
Phone.........................................................
Work
Phone......................................................... Mobile
..................................................................
YES/NO
Address .............................................................................................. Suburb ......................................................................................PC ..........................
Emergency Release YES / NO
Daily Pick Up YES / NO
(Telephone Authorisations for child collection cannot be accepted)
Consent to Medical Treatment YES/NO
Authorise to Administer Medication
YES/NO
Given Name/s ..................................................... Family
Name ...................................................................
Relationship to Child .................................... Home
Phone.........................................................
Work
Phone......................................................... Mobile
..................................................................
Address .............................................................................................. Suburb ......................................................................................PC ..........................
Emergency Release YES / NO
Daily Pick Up YES / NO
(Telephone Authorisations for child collection
cannot be accepted)
Consent to Medical Treatment YES/NO
Authorise to Administer Medication
YES/NO
Given Name/s ..................................................... Family
Name ...................................................................
Relationship to Child .................................... Home
Phone.........................................................
Work
Phone......................................................... Mobile
..................................................................
Address .............................................................................................. Suburb ......................................................................................PC ..........................
Emergency Release YES / NO
Daily Pick Up YES / NO
(Telephone Authorisations for child collection
cannot be accepted)
Consent to Medical Treatment YES/NO
Authorise to Administer Medication
YES/NO
PRIVACY STATEMENT
Our centre maintains records of children’s attendance, health, family financial matters, such as fee payments, and the developmental
records of each child as required by regulations. All information is confidential and is only available to parents/guardians of the
children concerned and by the request of FACS, NCAC and FAO. Special requirement records will be kept, if notified by a parent,
which may relate to a child’s culture or religion or if the child has a disability or other special need. The specific needs of all children
will be recorded.
PARENTAL AGREEMENT
Failure to agree to the following will result in termination of
enrolment In the event of any emergency, illness or accident concerning my child, I hereby give my
permission for the staff at this centre to seek medical, dental, or hospital attention for my child. Also, if
every reasonable effort to contact me has failed and the Doctor/Dentist contacted considers it necessary for
medication, anaesthetic or minor surgery to be necessary he/she has my permission to administer same. My
authority is given for transport by ambulance to the nearest casualty department and to be treated via
hospital protocol.
I accept liability for any medical, dental and/or ambulance expenses which may occur while my child is at the
Centre.
Signed
.................................................................Relationship .................................. Date
.................................................................
I hereby give permission for my child to be given age appropriate dosage of Panadol (as specified on the
packaging) in case of illness, once all attempts have been made to contact me for verbal permission.
Signed
.................................................................Relationship .................................. Date
.................................................................
I understand that allocated parking is the only acceptable form of arrival/departure at this centre. I
understand that I must hold my child’s hand whilst moving to and from the parking area, drive in a forward
motion at 5kms only, and reverse park into allocated car spaces when parking.
Signed
.................................................................Relationship .................................. Date
.................................................................
I give permission for my child to attend non-denominational scripture lessons provided by a qualified
scripture Teacher
Signed
.................................................................Relationship .................................. Date
.................................................................
I give permission for the staff at this centre to take photographs and videos of my child involved in play
experiences for the purposes of promoting the service as a high quality centre. This involves accreditation,
newspaper articles, portfolio observations, and displays within the service.
Signed
.................................................................Relationship .................................. Date
.................................................................
I give permission for the staff at this centre to display my child’s date of birth on a BIRTHDAY CHART, name
on a locker chart, and take frequent observations of my child for developmental progress, and educational
purposes.
Signed
.................................................................Relationship .................................. Date
.................................................................
I, and my partner, have read the centre’s Parent Handbook, and agree to abide by all conditions, policies
and procedures as outlined and stated herein. I also agree to abide by the centre’s policy of maintaining
fees two (2) weeks in advance. I also understand that fees are to be paid for all days that my child is
absent, sick, or on holidays, and that if fees shall fall into arrears, my child’s place at the centre will be
jeopardised.
Signed…………………………………………………………..Relationship………………..……………………….Date……
…………………………….
STATING GRIEVANCES
Informal
Talk to your child’s focus teacher. By talking, staff will acknowledge your feelings and action can then be
taken. If you feel that you have not been heard, make an appointment to see the Nominated Supervisor and
explain your concerns.
Formal
Briefly explain your concerns in your own words on the “Complaint Report form”. You should include enough
information for us to assess your grievance and determine the most appropriate response. If you feel the
need to take this complaint further, write to the Licensee:
c/- Young Scholars Child Care Pty Ltd
14 Ravensbourne Circuit
DURAL NSW 2158
A written response or telephone call will be returned to you by the Licensee.
TERMS & CONDITIONS
I have read and understand the following conditions:

NEW ENROLMENT FEE: All new enrolments (for new centres only) are required to pay $100.00 holding
fee. This $100.00 is to secure your position at the centre. Upon commencement of enrolment, this
enrolment fee will be deducted from the Holding Deposit. If enrolment is not commenced, the $100 is
not refundable.

HOLDING DEPOSIT: Upon enrolment two (2) weeks’ worth of fees are to be taken and held on your
account as a Bond and refunded to your account upon termination of placement. This must be paid by
cheque or money order, prior to your child’s commencement.

FEES IN ADVANCE: Fees must be paid two (2) weeks in advance at all times, if my fees fall
into arrears my child may lose his/her position. This must be paid by cheque or money
order, prior to commencement.

FEES PAID BY DIRECT DEBIT: All fees are to be made via Direct Debit. Complete and return the
attached Direct Debit form, prior to commencement.

LATE FEE: There is a late fee of $10.00 for the first 10 minutes or part thereof and for every additional minute
$5.00 will be charged. This is to be paid as an “on the spot fee” when late in collecting your child/ren.

ABSENT DAYS: Sick days and any other days your child is absent must be paid for. Please note that
the Family Assistance Office will only allocate 30 allowable absences per calendar year before your
Child Care Benefit is revoked.

CHANGE OF DAYS: Two weeks written notice must be given if you require additional days or are reducing the
days your child currently attends. Extra days are subject to availability and Priority of Access.

TERMINATION NOTICE: Two weeks written notice must be given if your child is leaving the Centre.

MEDIA DISPLAY: Videos, photographs, and audios of your child are authorised by you (the
parent/guardian) to be taken, transmitted, and distributed whilst your child is in our care for marketing
and display purposes.

SUN CREAM: Sun cream is to be applied to your child/ren by you upon arrival at our service, and given a stamp
on their hand as an indicator to our staff of your adherence to this principle.

HANDWASHING: All staff, children, parents and visitors to our Centre are to wash their hands upon arrival to
minimize the spread of infections throughout our service.

PARKING: All cars are to be parked in our allocated car spaces parked rear to kerb. Parents are not permitted to
park/drop off their children whilst paused on the road surrounding our service. A 50km limit must be abided by
whilst moving within our car-park
Signed
.............................................................. Relationship .............................. Date
..............................................................
Young Scholars
DIRECT DEBIT REQUEST
Request and Authority to debit the account named below to pay
Young Scholars
 Child attending the centre
Surname
Given Names
 Request and Authority to debit
Surname/Company Name
Given Names / Company
ABN
I/We request and authorise Young Scholars to arrange and charge for child care fees to be debited
through the BULK ELECTRONIC CLEARING SYSTEM from an account held at the financial institution
identified below, subject to the terms and conditions of the Direct Debit Request Service Agreement
[and any further instructions provided below].
 Name and address of the Financial Institution at which Account is held
Financial Institution
Name e.g. NAB, CBA
Address
[street]
[suburb]
[state]
 Details of Account to be Debited
Account Name (e.g. Mr +
Mrs Smith)
BSB (6 digits)
Account Number (excl.
BSB)
 Payment Details
The first debit may be made on the first Monday in …………………………………… (month) and at fortnightly intervals
thereafter.
 Acknowledgement
By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions
governing the debit arrangements between you and Young Scholars as set out in this request and in your Direct
Debit Request Service Agreement.
Signed
[If signing for a company, sign and print full name and capacity for signing ie Director]
Address
Dated