Existing Family Detail Update Form

Child's Confidential Updated Record - Out of School Hours Care (OSHC)

Please complete this form if one or more of your details has recently changed.

Windermere OSHC must collect the information in this form to meet regulatory requirements and maintain up to date records.

If you need help completing this form? please contact us on 1300 946 337.

Location *

1. Primary parent name

Please complete the following details even if they have not changed.

Who is considered a parent?

By law, the definition of a 'parent' includes:

a biological parent
a person with parental responsibility for the child under a decision or order of a court

Who is not considered a parent?

A person cannot be considered a parent if they have not obtained parental responsibility for the child under a decision or order of a court. This includes:

a parent's partner (non-biological parent)
a family member
another carer

Your details

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

Parent given name(s) *

Parent surname *

2. Child name/s

Please complete the following details even if they have not changed.

Child given name(s) *

Child surname *

Will the following updated details apply to another child? *

YesNo

Child given name/s *

Child surname *

Will the following updated details apply to another child? *

YesNo

Child given name/s *

Child surname *

Will the following updated details apply to another child? *

YesNo

Child given name/s *

Child surname *

3. Updated fields

Which of the following details have changed *

AddressMedical detailsEmergency contactsOther

Child's home address

Address *

Suburb *

Postcode *

Medical conditions

Does your child have any medical conditions? *

YesNo

My 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

Does your child have any diagnosed allergies? *

YesNo

Please list your child's allergies *

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

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

The educator will also complete a Risk Management & Communication Plan with you before your child commences care.

Action Plan *

Browse

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

YesNo

Please list your child's dietary restrictions *

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

YesNot applicable

*This is a legislative requirement for Family Day Care

Medicare details

Does your child have a Medicare number? *

YesNo

Medicare number *

Medicare reference number *

Details of your child's doctor and Maternal & Child Health Centre

Name of medical service *

Doctor's name

Doctor's phone number *

Doctor's address *

Suburb *

Postcode *

Do you have ambulance cover? *

YesNo

Additional needs

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

Does your child have any additional needs? *

YesNo

Is your 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

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Emergency contacts

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 Family Day Care Educator to be an authorised contact.
Only included people who are over 16 years of age time

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 your childbe notified of an accident, trauma or illness involving your childbe notified of an emergency involving your child if a parent cannot be contactedconsent to emergency medical or ambulance treatment for your childconsent to administration of medication to my childauthorise an educator to take your child outside the family day care residents 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: *

Other

Please specify which other details have changed *

11. Declaration and consent

I, the parent completing this form

Declare that the information in my 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 educator *

Authorise the Person with Management and Control, Nominated Supervisors or educator at the service to seek necessary medical treatment for my child from a registered medical practitioner, hospital, dental or ambulance that includes the transportation of my 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 to my/our child/ren being bathed when attending to immediate hygiene needs *

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 ofeducation and training *

Agree to my/our child/ren going on outings outside the Family Day Care Educator’s home and understand that all reasonable care will be taken in the supervision of my child *

Permit my/our child/ren to travel in a vehicle registered with the Family Day Care Service, with a registered Educator or Coordination Unit staff *

Please sign here *

Clear

Name *

Date *

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