Enrol your child in creche
Personal Details
Child's First Name:
Child's Last Name:
Child's Date of Birth:
First Parent/Guardian's First Name:
First Parent/Guardian's Last Name:
Parent/Guardian's Date of Birth:
Address:
Suburb:
Postcode:
Email:
Contact Number:
To be used when in the centre
Second Parent/Guardian's First Name:
Second Parent/Guardian's Last Name:
Address (if different to first parent):
Suburb:
Postcode:
Email:
Contact Number:
Allergies/Illnesses
Does your child suffer from any medical or physical condition that needs to be brought to the attention of the staff? (For example: allergies; anaphylaxis; disability; medical conditions)
Please indicate:
Yes
No
If yes, specify details and medication required:
Does your child suffer from anaphylaxis or asthma?:
Yes
No
If yes, if your child has an Epipen or an asthma plan
Please supply action plan and tick the box below:
I acknowledge I must supply an allergy treatment/asthma action plan to crèche staff.
I authorise crèche staff to administer my child’s Epipen or asthma medication in the case of emergency.
Medical Treatment
In the event of any accident or illness, I authorise staff to obtain medical treatment and/or transport by ambulance for my child and agree to pay expenses incurred for medical treatment and transport.
Medical Authorisation:
Yes
No
Immunisation
Is your child immunised?:
Yes
No
Emergency Contact and Authorisation to Collect Your Child
Please list a person who is authorised to collect and care for your child in your absence or if the parent/guardian is unavailable to be contacted in the event of any accident, injury, trauma or illness of the child.
First Name:
Last Name:
Relationship to child:
Address:
Suburb:
Contact Number:
Photo Permission
At times, photos may be taken in the Crèche to capture the children playing in our Crèche environment for promotional purposes. Parents will be advised if a photo has been taken.
Photos:
Yes
No
Declaration
Declaration:
I declare that the information above is complete and accurate.
I acknowledge that I have read and understood The ARC Carnaby’s Club Crèche Handbook and agree to abide by the conditions set out in the handbook.
I acknowledge that I must remain in the centre at all times while my child is in the crèche.