Carnaby Club Crèche Enrolment Form

This form must be completed before your child can begin at our creche.

Please  complete a separate form for each child you wish to enrol.
 
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Personal Details

To be used when in the centre

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 : special dietary requirements; allergies; anaphylaxis; medical conditions such as ADD, epilepsy, asthma; special needs)
 
Please indicate:

Does your child suffer from anaphylaxis or asthma?:

If yes, if your child has an Epipen or an asthma plan

Please supply action plan and tick the box below. :

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:

Immunisation

Is your child immunised?:



Court Orders

Are there any Family Court orders relating to the powers, duties or responsibilities affecting custody of or access to the child?
If yes, I acknowledge that a copy of the order must be provided to the Children’s Services Team Leader to protect the safety and care of their child. 
 

Emergency Contact and Authorisation to Collect Your Child


Please list at least two people who are 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.

Person 1

Person 2

Person 3

Person 4

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:

Child's Likes and Dislikes

Your child’s likes and dislikes are important to us. Please list any details about your child that will assist with our program and make your child’s stay with us a happy one.
 
 

Declaration

Declaration:







 
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