Creche Enrolment Form

Parent/Guardian Details

Membership Number

First Name*

Surname*

Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Email*

Date of Birth*

Phone number*

Second Parent/Guardian's Details

Please enter details for the second parent/guardian below

Membership Number

First Name

Surname

Address

Street Address:*

City:*

State:*

Post Code:*

Country:

Date of Birth

Phone Number

Child Details

Child Details 2

Child's First Name

Child's Surname

Platinum Family Nomination

YesNo

Date of Birth

Gender

Important/Medical Information

Please provide details of any information regarding any medical or physical conditions pertaining to your child/children.
This may include but not limited to allergies, anaphylaxis, ADD, epilepsy, asthma, court orders etc..
(Please supply a copy of documents such as court orders, allergy plans, sign language etc..) Please type N/A if not applicable.

Medical Information

Medical Action Required

Important File Upload

Max File Size: 100.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .pdf, .png

Child Details 3

Child's First Name

Child's Surname

Platinum Family Nomination

YesNo

Date of Birth

Gender

Important/Medical Information

Medical Information

Medical Action Required

Important File Upload

Max File Size: 100.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .pdf, .png

Child Details 4

Child's First Name

Child's Surname

Platinum Family Nomination

YesNo

Date of Birth

Gender

Important/Medical Information

Medical Information

Medical Action Required

Important File Upload

Max File Size: 100.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .pdf, .png

Emergency Contact Details

Please provide in addition to parent/guardian - as one may be unavailable.

First Name*

Surname*

Phone Number*

Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Relationship to child*

Parent Statement

I accept :
• I have read and agree to the provisions detailed in the Crèche Parenting Handbook.
• I must stay within the facility (inside the building) while my child/children attend the crèche.
• My child/children can attend programs on the indoor courts in Wanangkura Stadium (Kiddo, Playgroup Sessions, etc.).
• Photos may be taken of my child/children whilst participating in activities, and I agree to the photos being used as described in the Crèche Parenting Handbook.
• I have discussed the immunisation status of my child/children on enrolment.
• Only the adults listed above have approval to collect my child/children.
• Only children ages 8 weeks – 11 years of age are permitted entry into the crèche.
• I am allowing authorisation for the drop off and/or collection of my child/children to those stated above.
• I will not bring my child/children to the crèche if they are unwell.
• This is an allergy-aware facility, and I will not bring nuts into the centre or any other foods as described in the Crèche Parenting Handbook.
• I am responsible, at all times, for my child/children while they attend the crèche.
• I must immediately return to the crèche area to attend to my child/children should I be requested.
• I will not be late to collect my child/children from the crèche, and a fine may apply.
• My child/children are recommended to be immunised before using crèche facilities.
• I authorise the obtaining of medical or hospital treatment for my child/children as required and agree to cover any related expenses.
• In case of emergency, I consent to my child/children being transported by ambulance. I understand I will be consulted where possible

Comments

Signature of parent/guardian

Date

Navigation

Parent/Guardian Details

Child Details

Child Details 2

Child Details 3

Child Details 4

Emergency Contact Details

Parent Statement

Validate and Submit Form