Child's Gender
MaleFemale






Has Your Child Been Immunised?
YesNo



Please attach an up to date Australian Immunisation Register (AIR) with this enrolment form. Enrolment cannot be completed without an AIR.

Please tick what days your child would like to attend Growing Minds.
(Minimum requirement of two placements a week)

Before School Care

MondayTuesdayWednesdayThursdayFriday

After School Care

MondayTuesdayWednesdayThursdayFriday

Vacation Care

MondayTuesdayWednesdayThursdayFriday






Is the student of Aboriginal or Torres Strait Islander origin?
Yes (Please specify)No

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PARENT/CARER ONE WITH WHOM THIS STUDENT NORMALLY LIVES

Title
MrMrsMasterMiss

Gender
MaleFemale









PARENT/CARER TWO

Title
MrMrsMasterMiss

Gender
MaleFemale









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Is your child eligible for the CCS rebate?
YesNo






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Please list the following people who are authorised to pick up your child from Growing Minds (Excluding Carer 1 & 2)



Confirm
I have confirmed with the authorised person



Confirm
I have confirmed with the authorised person

Emergency Contact






Authorised nominee means a person who has been given permission by a parent or family member to collect the child from the education and care service or the family day care educator. See section 170(5) of the Law. Growing Minds will take the Emergency contact to be any person who is authorised to consent to medical treatment of, or to authorise administration of medication to, the child; and any person who is authorised to authorise an educator to take the child outside the education and care service premises.
I agree

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Are there any special circumstances about the student seeking to be enrolled that Growing Minds should know prior to enrolment?
(E.g. living apart from parental supervision, subject of care arranged by the state)
YesNo


COURT ORDERS

Does your child have any court orders affecting them? (e.g. custody of a child etc)
YesNo


STUDENTS WITH ADDITIONAL LEARNING AND SUPPORT NEEDS, INCLUDING DISABILITY

Does the student require support for learning because of disability?
YesNo

List the disability


Has any previous educational provider (including schools) prepared a documented plan to support the student’s additional learning needs?
YesNo



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Student medical details and health conditions

It is essential you inform Growing Minds before your child is enrolled if he or she has any medical conditions. You must include any known allergies. You should contact Growing Minds as soon as you are aware of any newly diagnosed allergies, other medical conditions or changes to an existing condition. This will assist Growing Minds to support the safety and wellbeing of your child and allow planning to occur to determine the best strategy to meet the individual’s health and support needs of your child. This is vitally important for your child’s safe participation at Growing Minds.







Please provide the name, address and phone number of any other doctor or medical specialist who may currently be treating your child for any allergy or other medical condition you may list. If more than one, please clearly state.





If your child has a documented plan to support any health or medical needs from their school or other occasional care services, please provide it to Growing Minds.

DIETARY REQUIREMENTS


ALLERGIES – THESE CAN INCLUDE ALLERGIES TO INSECT STINGS, DRUGS, LATEX, FOOD (E.G. NUTS, EGGS, PEANUTS) OR OTHER.


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Student medical details and health conditions

Has a doctor diagnosed this allergy?
YesNo

Is this a severe allergy (anaphylaxis)?
YesNo

Anaphylaxis is a severe, potentially life threatening, allergic reaction.

>Has your child been hospitalised with a severe allergic reaction (anaphylaxis) or any other allergy?
YesNo


Does your child have an ASCIA Action Plan for Anaphylaxis?
YesNo


Has your child been prescribed an adrenaline autoinjector (i.e. EpiPen/Anapen)?
YesNo

If your child has been prescribed an adrenaline autoinjector, please advise where it is located in the child's bag. Growing Minds has an Epipen on site at all times.
Each time your child is prescribed a new adrenaline autoinjector the doctor should issue an updated ASCIA Action Plan for anaphylaxis. It is important that a copy of an updated plan is provided to Growing Minds.


Does your child have an ASCIA Action Plan for Allergic Reactions?
YesNo



Growing Minds will require further details in relation to prescribed medication on enrolment. Parents of children who require their child to be administered prescribed medication at Growing Minds must complete a written request. Growing Minds can provide you with a copy of a request form.
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Medical Conditions other than Allergies and Anaphylaxis (e.g. Asthma, Severe Asthma, Diabetes, Epilepsy)

Please identify and provide details below of any medical condition for which your child is being treated.


Has the doctor diagnosed this condition?
YesNo

Has your child been hospitalised with this condition?
YesNo


Does your child have a documented action plan from a doctor (e.g. Asthma action plan)?
YesNo


Is your child taking prescribed medication for this condition?
YesNo


Growing Minds will require further details in relation to prescribed medication on enrolment. Parents of children who require their child to be administered prescribed medication at Growing Minds must complete a written request. Growing Minds can provide you with a copy of a request form.

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STUDENT DETAILS – ADDITIONAL INFORMATION

Students history relevant to risk assessment

Growing Minds has a responsibility to assess an manage any risk of harm to its staff and students. This application gives you the opportunity to provide us with information that will help facilitate the smooth transition of the student into our centre. This may include a behaviour management plan or other appropriate strategies directed at meeting the particular needs of the student. The action taken in response to the information you provide will help ensure the safety of this student, other students and staff members.

To your knowledge, is there anything in the students history or circumstances (including medical history) which might pose a risk of any type to this student, other students or staff at Growing Minds?
YesNo



Does the student have any history of violent behaviour?
YesNo


Has the student ever been suspended or expelled from any previous school(s)/after school centre(s)?
YesNo

Actual violence to any person?
YesNo


Possession of a weapon or any item used to cause harm or injury?
YesNo


Threats of violence or intimidation of staff, students, or others at the school?
YesNo


Are you aware of any other incidents of the kind listed above in which the student has been involved outside school hours?
YesNo


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PUBLISHING STUDENT INFORMATION

Growing Minds may publish your child for the purposes of sharing his/her experiences with other students, informing schools and the broader community about Growing Minds activities and recording student participation in projects or community service.

This information may include your child’s name, age, class and information collected at Growing Minds such as photographs, sound and visual recordings of your child, your child’s work and expressions of opinion such as interactive media.
The communications in which your child’s information may be published include but are not limited to:

• Growing Minds website, blogs, newsletters, promotional materials (which may be published in print or electronically) and school newsletters.

• Growing Minds social media accounts such as YouTube, Facebook, Twitter and Instagram

Parents should be aware that when information is published on public websites and social media channels it can be linked by third parties and may be discoverable online for a number of years, if not permanently. Search engines may also cache or retain copies of published information.

PERMISSION TO PUBLISH

I have read the information about publishing student information (above) and

I give permissionI do not give permission

For Growing Minds After School to publish information about my child in publicly accessible communications. This permission remains effective until I advise othewise.

PLACEMENT AGREEMENT

I have read the Parent Handbook/Enrolment Form and agree to abide by the Program’s Policies as outlined in the booklet including late collection and collection of children whilst under the influence of alcohol or drugs.

I am aware that my child’s permanent booking fee will be charged for any day that he/she is absent.

I agree to advise Growing Minds in writing a future absence or a change of days for my child/ren. I will give at least one week (7 days) notice to make permanent changes to my bookings.

I am aware that if my child leaves the service I am required to pay full fees for any days that my child does not attend the service leading up to the date of discontinuation of care (2 weeks notice period applies).I understand
the CCS Guidelines around this policy (see Parent Handbook). Growing Minds will also charge during public holidays when they fall within our operational period as per industry standard (excluding Christmas Closure).

I am aware that throughout the calander year, my child can take up to 10 days off in total during the four NSW School Terms and have the daily charged waived given a written 7 day notice period. The 10 day allowance can be used for any reason inc but not limited to family holidays, medical appointments, sick days, school events etc). Daily charges apply for booking cancellation thereafter. Growing Minds does not have a mandatory attendance during vacation care, this is our opt in service and you will not be charged during this period unless bookings are secured for your child/ren.

I will contact Growing Minds at the earliest convenience when I know my child is going to be absent from the program. I am aware that I cannot make a casual booking more than two weeks in advance.

I agree to exclude my child from the program when they are unwell, especially if the illness is contagious. I will provide a clearance certificate from a Doctor if required for infectious illnesses.

I am aware that my child may be excluded from the program if they are not immunised and there is an outbreak of an infectious disease and I understand that my fees will still be charged during this time.

I understand that if I make a casual booking
I am unable to cancel that booking and therefore if my child is absent I will be required to pay an absent casual fee.

I understand that if I am late to pick up my child from the after school care program that I will be charged a late fee (up to $30.00).

I am aware that if my child exceeds 42 days absence in a financial year that Child Care Subsidy will no longer be applied to my child’s absence/s for the remainder of the financial year.

I give permission for the program supervisor and program educator/s to seek emergency medical, hospital or ambulance services/ transport and that I the child Guardian will be contacted and agree to pay all costs involved.

It is the parent/guardian’s responsibility to check CAS statements regularly and see if CCS is being deducted weekly. Parent/guardians have 28 days after the date of the booking to claim the CCS through Centrelink if they haven’t received it from the service.

Under CCS rules, if your child/ren are away as absent on the first or last day of enrolment, they would not receive the CCS payment, and thus pay full fee.

I agree to sign my child in every session they attend (Before School Care, After School Care & Vacation Care). I agree to sign my child in and out using the iCheckin system (Digital signin/signout technology)

I agree to submit my Centrelink Child Care Subsidy letter to Growing Minds upon enrolment and any new letters that have updated and adjusted your entitlement from Centrelink.

CONSENT AND DECLARATION

I have provided information about the learning and support needs, including health condition(s) and/or special need(s) and/or history relevant to a risk assessment, related to the student listed in this application form.

I consent to Growing Minds After School seeking information from previous schools, NSW government departments, public hospitals or other organisation that may also hold information related to the assessment of the student named on page 1.

I consent to the health professional(s) treating any medical or health condition identified in this application, to provide Growing Minds After School with information about any condition that has been identified in this application. This may include any other aspects of the student’s health that may impact on the condition or the health and safety of this student or other students and staff at Growing Minds.

I consent to have my child driven by bus, car, another vehicle or other forms of transport from the Growing Minds location to the nominated school (Before School Care) and from the nominated school to the Growing Minds location (After School Care).

I have read the information on this page concerning the collection of personal information and publishing student information.

I declare that the information provided in this application is, to the best of my knowledge and belief, accurate and complete.

Where I have given personal information about other people I have done so with their authorisation.

I am aware that if information I have given is false or misleading, any decision made as a result of this application may be changed.





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ENROLMENT CHECKLIST

Please ensure you have provided the following documents if applicable to your child. Incomplete enrolments will not be accepted:

Full Completed Enrolment Form

Full Completed Direct Debit Form

AIR - Australia Immunisation Record

Any Medical Action Plans

Centrelink Benefit Letter


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