Out of School Hours Care (OSHC) Enrolment

Please complete this form for each child you are enrolling. Windermere OSHC must collect the information in this form to meet regulatory requirements.

The documents you will require to complete this enrolment are:

Action plan - if your child has a diagnosed medical condition or allergy.
Court order documents - if applicable.
Imunisation documents.
Medicare card.
Additional needs supporting documents - if applicable (e.g specialist letters).

Thank you and we look forward to having your child in our care!

Are you currently accessing Windermere OSHC? *

YesNo, but I have in the last 12 monthsNo, I haven't

At which school will the child be accessing care? *

What grade is this child currently attending? *

How did you hear about us? *

Please specify *

1. Child's details

Given name(s) *

Surname *

Date of birth *

Country of birth *

Gender *

MaleFemaleOther

Child's home address

Address *

Suburb *

Postcode *

Language(s) spoken in the child's home *

Cultural background(if applicable)

Is the child of Aboriginal or Torres Strait Islander heritage? *

NoYes, AboriginalYes, Torres Strait IslanderYes, both Aboriginal and Torres Islander

Child's Customer Reference Number (CRN) *

Please make sure you have all 10 numbers listed above for the CRN.

Permanent Care Details

Permanent care means the child will have an ongoing booking with no change.

Do you wish to make a permanent care booking? *

YesNo

Please select the date you wish to start the child's permanent care *This is the first day you wish to drop off the child to care

Before and/or after school care on Monday *

Before school careAfter school care

Before and/or after school care on Tuesday *

Before school careAfter school care

Before and/or after school care on Wednesday *

Before school careAfter school care

Before and/or after school care on Thursday *

Before school careAfter school care

Before and/or after school care on Friday *

Before school careAfter school care

Casual Care Details

Casual care means the child will have a flexible enrolment with no set dates.

Do you wish to make a casual care enrolment? *

YesNo

Please call 1300 946 337 or email OSHC@windermere.org.au to book your casual care dates.

2. Parent(s)/ Guardian(s) details

Your details

The person completing this form must be the parent/guardian with the CRN linked to the child.

I am completing this form as a parent/guardian of the child. The details I provided below will be my own. *

Given name(s) *

Surname *

Date of birth *

Country of birth *

What is your relationship to the child? *

MotherFatherOther

Does the child live with you? *

YesNo

Your address *

Your contact details

Please provide as many contact details as possible. At least one phone number is reuired.

Home phone

Mobile phone *

Email address *

Please note enrolment booking times and start date will be confirmed once email confirmation has been sent to parent one's email address. (Please check Junk mail)

My contact preference is *

EmailPhoneMobile

Language details

What is the main language spoken at home? *

Cultural background(if applicable)

Do you need an interpreter? *

YesNo

Work details

Are you working? *

YesNo

Occupation *

Workplace name

Workplace address

Street Name & Number

Suburb

Postcode

Work phone

Child Care Subsidy

In order for the service to provide Child Care Subsidy (CCS), the person applying for CCS must provide their Customer Reference Number (CRN) and the CRN of the child. These will be different for parent/ guardian and child.

Are you the parent/ guardian applying for the Child Care Subsidy? *

YesNoN/A

Your Customer Reference Number (CRN) *

Your date of birth *

Does the child have another parent? *

YesNo

Parent/Guardian 2 details

Given name(s) *

Surname *

Date of birth *

Country of birth *

What is the main language spoken at home? *

Cultural background(if applicable)

Email address *

Mobile phone

Occupation *

Does parent/guardian 2 live with you?

YesNo

Does parent/guardian 2 live with the child?

YesNo

Street Name & Number

Suburb

Postcode

3. Court orders

Are there any:

Court orders, parenting orders or parenting plans concerning the powers, duties and responsibilities, or authorities of any person in relation to the child or access to the child?
Details of court orders relating to the child's residence or the child's contact with a parent or other person?

YesNo

Please upload copies of these documents *

Browse

The child will not be able to attend OSHC if you do not provided us with a copy of the current document(s).

You must provide us with updated or amended court orders, parenting orders or parenting plans if they are changed.

If these documents change or if any of the above become applicable, I will provide updated versions to Windermere and/or my child's educator *

4. Authorised contacts other than a parent/guardian

This section is for you to authorise other people to act on your behalf in certain circumstances.

You cannot include those who are already listed as parents / guardian 1 and 2.
You must provide two (2) authorised contacts.
You cannot authorise your Windermere Out of School Hours Care educator to be an authorised contact.
Only included people who are over 16 years of age.

Contact 1

Full name *

Address *

Suburb *

Postcode *

Please fill in at least one phone number.

Work phone

Mobile phone *

Relationship to your child *

Please tick the boxes below to confirm the level of authorisation you give to this person. This authorised contact can: *

collect the childbe notified of an accident, trauma or illness involving the childbe notified of an emergency involving the child if a parent cannot be contactedconsent to emergency medical or ambulance treatment for the childconsent to administration of medication to the childauthorise an educator to take the child outside the school on excursions/regular outings

Contact 2

Full name *

Address *

Suburb *

Postcode *

Please fill in at least one phone number.

Work phone

Mobile phone *

Relationship to your child *

Please tick the boxes below to confirm the level of authorisation you give to this person. This authorised contact can: *

collect the childbe notified of an accident, trauma or illness involving the childbe notified of an emergency involving the child if a parent cannot be contactedconsent to emergency medical or ambulance treatment for the childconsent to administration of medication to the childauthorise an educator to take the child outside the school on excursions/regular outings

5. Immunisation and health

Medicare details

Does the child have a Medicare number? *

YesNo

Medicare number *

Medicare reference number *

Details of the child's doctor:

Name of medical service *

Doctor's name

Doctor's phone number *

Doctor's address *

Suburb *

Postcode *

Do you have ambulance cover? *

YesNo

Please provide Windermere with the child’s immunisation History Statement (this can be downloaded from MyGov or Medicare).

Documents we cannot accept

The child's Health Record (blue book)
Health & Development Record (green book)
Overseas immunisation documents
Homeopatic immunisation documents
Statutory declarations
Conscientious objection and vaccination objection on non-medical grounds
Certificates from your doctor

*Windermere Out of School Hours Care do not site health records.

Copy of the child's immunisation documents

Browse

6. Medical conditions

Does the child have any medical conditions? *

YesNo

The child has been: *

diagnosed as being at risk of anaphylaxisprescribed an adrenaline auto-injector device (AAID)diagnosed with asthmadiagnosed with epilepsydiagnosed with diabetesdiagnosed with eczemadiagnosed with another condition

Please explain your other condition *

Does the child have any diagnosed allergies? *

YesNo

Please list the child's allergies *

Please upload the child's current Action Plan (within the last 12 months) for their condition. The child's doctor can provide this plan.

It is important that you ask for a copy of the Guidelines for the child's medical condition. This will help you understand how the educator will support the child.

We will also complete a Risk Management & Communication Plan with you before the child commences care.

Action Plan *

Browse

Does the child have any dietary restrictions (including cultural)? *

YesNo

Please list the child's dietary restrictions *

I agree to have the child's medical details displayed within the service. *

YesNot applicable

*This is a legislative requirement for OSHC

7. Additional needs

Windermere is committed to providing an environment that values and respects the needs of all children to fully participate.

Does the child have any additional needs? *

YesNo

Is the child linked to other professional services? *

YesNo

Example include a paediatrician, an early intervention service, therapists, Preschool Field Officers and an Inclusions Support Facilitator.

Name of professional service *

Please provide any supporting documentation *

Browse

Additional professional service

Additional supporting documentation

Browse

8. Filming and photography consent

A parent/ guardian's consent is required before images and recordings can be taken of the child.

I consent to:

Audio, video and still images and power point presentations taken by staff/educators to be used within the service for programming use *

YesNo

Audio, video & still images being taken by staff/educators/parents/guardians of other children where the child may also be in the photo *

Yes No

Audio, video and still images being taken by staff/educators in the education and care service venue and displayed?

YesNo

Audio, video & still images being taken for use in newspaper, websites (including Windermere’s Website), marketing & other external publications?

YesNo

If we require consent to use audio, video and still images that are not covered by the points above, we will ask you for separate consent to suit the situation.

9. Privacy

Our Privacy Policy is about how we handle your personal information.

We collect personal information from you when it is reasonably necessary for a business purpose. That means we collect it to supply you with the services and/or products you have asked for and to provide you with the best possible service.

Other reasons we collect personal information are to:

Understand you and how we can meet your needs now and in the future
Develop or evaluate services and products
Manage our business
Comply with our legal obligations

We may collect personal information like your name, address, date of birth, gender, occupation, location, contact details or payment details depending on the activity you undertake with us. There are a few different ways we collect this information.

For more information please see our Privacy Policy.

I have read and agree to Windermere's Privacy Policy *

10. Sunscreen

Educators will supervise children to apply sunscreen in accordance with SunSmart Victoria Guidelines.

I authorise educators to supply sunscreen to the child if I have not provided sunscreen

11. Declaration and consent

I, the parent completing this form

Declare that the information in the Child's Confidential Record is true and correct and undertake to immediately inform the educator at the service in the event of any change to this information *

Understand that during an emergency or drill where evacuation is necessary that the child may need to leave the service under the direction and supervision of the Windermere staff member or educator *

Authorise the Person with Management and Control, Nominated Supervisors or educator at the service to seek necessary medical treatment for the child from a registered medical practitioner, hospital, dental or ambulance that includes the transportation of the child by an ambulance from the service in the event of an emergency. I agree that all associated medical expenses will be my responsibility *

Declare that the information in this enrolment form is true and correct and identifies all allergies and medical conditions known to me at this time *

Agree to complete new enrolment form/s in the event of any change to this information and if required by Windermere *

Agree to collect or make arrangements for the collection of the child referred to in this enrolmentform if he/she becomes unwell at the service *

Understand that my/our written permission will be sought for excursions outside the service *

Consent for Staff/Educators/Program Coordinators to inspect your child’s hair for head lice as deemed necessary during the year *

Consent to the use of band aids on my/our child/ren if required *

Agree to read and approve the complying written agreement as required by the department of education and training *

Agree to my/our child/ren going on outings outside the school and understand that all reasonable care will be taken in the supervision of my child *

Please sign here *

Clear

Name *

Date signed *

Staff member's signature

Draw signature|Type signatureClear

Staff member's name

Staff member date signed

Staff member's position

12. Payment of fees

I/We authorise and request HubHello Pty Ltd ACN 160 176 018 to debit payments from my/our account, as specified below, at intervals and amounts as directed by Windermere Child and Family Services (“The Business”) as per the terms and conditions of my/our agreement with the Business and in accordance with the Direct Debit Request and the Hubhello DDR Service Agreement.

Your direct debit will commence Friday fortnight as per the invoice cycle. Debit amount = Balance Due

Fees:

Bank AccountTransaction Fee: $0
Credit CardSurcharge:
- VISA/MasterCard: 0.90%
Failed Transaction Fee: $2.75

Payment Method

I wish to pay via *

Debit from Credit CardDebit from Bank Account

Credit Card *

VisaMastercard

Credit Card Number *Do not include spaces between the numbers.

Name of Cardholder *

Expiry Date *

BSB Number *

Account Number *

Account Holder Name *

I/we authorise HubHello Pty Ltd CAN 160 176 018 to debit my/our account at the financial institution identified through the bulk electronic clearing system (BECS), in accordance withthe debit arrangement stated above and this Direct Debit Request and as per the HubHello DDR Service Agreement provided. *

Name *

Date *

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