Vacation Care Enrolment Form

2026 Autumn School Holiday Vacation Care

Location:

St John the Baptist Primary School, 172 Station Street, Koo Wee Rup, VIC

Lang Lang Primary School, 52 Westernport Rd, Lang Lang VIC 3984

Fees:

Daily fee of $87.72

Incursion day fee of $107.22

Please complete this form for each child you are enrolling. Windermere Vacation Care 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.
Immunisation documents.
Medicare card.
Additional needs supporting documents - if applicable.

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

Are you currently accessing Windermere Vacation Care? *

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

If you are already accessing our OSHC services, please go straight to the booking form here:

St John the Baptist Primary School - Vacation Care Booking Form

Lang Lang Primary School - Vacation Care Booking Form

Please select a school for vacation care enrolment *

How did you hear about us? *

Please specify *

1. Child's details

Given name(s) *

Surname *

Date of birth *

Country of birth *

Gender *

MaleFemale

What school does your child attend? *

What other school does your child attend? *

Child's Home Address

Address *

Postcode *

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

Cultural background(if applicable)

Is your 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 select the days you would like your child booked into Vacation Care *

Tuesday 7th April - Easter CelebrationsWednesday 8th April - A Pocket Full of Tricks (magic show incursion)Thursday 9th April - Sports DayFriday 10th April - Wild Life Adventures (incursion)Monday 13th April - Careers Day - Police/Ambulance incursion (free)Tuesday 14th April - Butterfly Fly Away (incursion)Wednesday 15th April - Op Shop ExcursionThursday 16th April - Remote Controlled Cars Day (Incursion)Friday 17th April - Movie Day

2. 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

Please list your child's 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.

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

Action Plan

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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 Vacation Care

3. Parent(s) details

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.

I am completing this form as a parent 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 your child? *

MotherFatherOther

Does your child live with you? *

YesNo

Your contact details

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

Home phone

Mobile phone *

Email address *

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.

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

YesNo

Your Customer Reference Number (CRN) *

Does the child have another parent? *

YesNo

Parent 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 2 live with you?

YesNo

Does parent 2 live with your child?

YesNo

Street Name & Number

Postcode

4. Authorised contacts other than a parent

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 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 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: *

5. 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 *

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Your child will not be able to attend Vacation Care if you do not provide 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 my Windermere and/or my child's educator *

6. Immunisation and health

Please provide Windermere with your 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
Homeopathic 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 your child's immunisation documents

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Medicare details

Does your child have a Medicare number? *

YesNo

Medicare number *

Medicare reference number *

Details of your child's doctor/health practitioner

Name of medical service *

Doctor's name

Doctor's phone number *

Doctor's address *

Suburb *

Postcode *

Do you have ambulance cover? *

YesNo

7. 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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8. Filming and photography consent

A parent's consent is required before images and recordings can be taken of their 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

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

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

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

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.

Do you agree to your child and yourself taking part in photos, videos and audio?

YesNo

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
Make ads more relevant to you
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.

For more information about how we use sunscreen to protect your child, please ask your educator for a copy of the Weather Protection Guidelines.

I authorise educators to apply the sunscreen I have provided for my child

I authorise educators to apply sunscreen they provided if I have not provided sunscreen for my child

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 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

YesNo

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 *

Permit my/our child/ren to travel in a vehicle registered with Windermere, with a registered Educator or Coordination Unit staff *

Please sign here *

Clear

Name *

Date *

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 be processed seven days before commencement of the Vacation care period. This amount will be the estimated Gap Fee payable.

Fees:

Bank Account Transaction Fee: $0
Credit Card Surcharge:
- VISA/MasterCard: 0.90%
Failed Transaction Fee: $2.75

Payment Method

If you would like to pay by Debit/Credit card, please contact ar@windermere.org.au and our Accounts Receivable Officer will be in touch with you.

BSB Number *

Account Number *

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 *

Mobile Phone *

Email Address *

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