Coastwide Family Day Care Enrolment Form - New

Coastwide Family Day Care Enrolment Form

Please complete all sections of the Coastwide Family Day Care Enrolment Form, including:

  • Your Customer Reference Number (CRN) and the CRN for all children enrolling
  • Your child/children's Medicare Number

Including providing an electronic copy of:

  • Evidence to confirm your child’s/children ID, which can be either, a copy of their Birth Certificate / Passport / Citizenship Certificate (preferred) or a copy your Medicare card
  • A copy of the Immunisation History Statement for all children enrolling
  • A copy of any Health or Asthma Plans if appropriate
  • A copy of any court orders which may be in place
  • Electronic copies may be pdf, jpg, gif, png, doc or docx and a maximum size of 1MB each

Parent/Guardian 1 Personal Details *

Phone Contact

Parent/Guardian 1 Date of Birth

9 numbers and 1 lowercase letter only "eg:123456789a"

Section

9 numbers and 1 lowercase letter only "eg:123456789a"

Parent/Guardian 2 Personal Details:

Phone Contact

Parent/Guardian 2 Date of Birth

Family Medical Details

Medical Practitioner or Medical Service

Dental Practice

Child/Children Enrolment Details

Child 1 Personal Details & Booked Care

Date of Birth

Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
9 numbers and 1 lowercase letter only "eg:123456789a"
Medical Information
1234/56789/1-1 (the last number relating to the number of your child on the card)
(If no, please provide more information below)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
We will be in touch to discuss the additional documentation required prior to your child starting care
Guardianship, Custody and Parenting Court Orders
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Child 2 Personal Details & Booked Care

Date of Birth

Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
9 numbers and 1 lowercase letter only "eg:123456789a"
Medical Information
1234/56789/1-1 (the last number relating to the number of your child on the card)
(If no, please provide more information below)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
We will be in touch to discuss the additional documentation required prior to your child starting care
Guardianship, Custody and Parenting Court Orders
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Child 3 Personal Details & Booked Care

Date of Birth

Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
9 numbers and 1 lowercase letter only "eg:123456789a"
Medical Information
1234/56789/1-1 (the last number relating to the number of your child on the card)
(If no, please provide more information below)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
We will be in touch to discuss the additional documentation required prior to your child starting care
Guardianship, Custody and Parenting Court Orders
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Child 4 Personal Details & Booked Care

Date of Birth

Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
9 numbers and 1 lowercase letter only "eg:123456789a"
Medical Information
1234/56789/1-1 (the last number relating to the number of your child on the card)
(If no, please provide more information below)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)
We will be in touch to discuss the additional documentation required prior to your child starting care
Guardianship, Custody and Parenting Court Orders
Maximum upload size: 5MB
Document format: .jpg .gif .png .pdf .doc .docx (max size 5MB)

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Please list the days and hours of care agreed with your Educator. For Before and After School Care please list both sessions of care required.

To add more days click the 'Add day' button
:
:

Care Requirements

Please click on field and use calendar to select date

Routine Excursions

Family Emergency Permissions

To meet our responsibilities in the case of an emergency, incident or illness the Educator or Coordination Unit staff member may seek medical treatment for the child from a registered medical practitioner, hospital or ambulance service, and may access transportation by the ambulance service or other authorised vehicle.

In the case of an emergency you will be contacted as soon as possible.

In addition in the case of a fever, the Educator or Coordination Unit staff member may administer paracetamol or ibuprofen. Prior to administering paracetamol or ibuprofen verbal permission will be sought.

Family Photo Permission

Your Educator or Coordination Unit staff member may take photographs of your child whilst in care.

Family Emergency Contacts

Please provide at least two emergency contacts other than Parent/Guardian. Emergency Contacts must be aged 18 years or over.

Emergency Contact 1

Phone Contact
More than one option can be selected.

Emergency Contact 2

Phone Contact
More than one option can be selected.

Agreement between Parent/Guardian and Coastwide Family Day Care (Complying Written Agreement)

To finalise your enrolment please confirm that you agree to follow the Coastwide Family Day Care Guidelines and Policies as detailed in the Family Handbook and agree to:

1. Pay the enrolment fee in the first week of care
2. Pay the fees according to the Fee Schedule used by the Educator providing the care which I have sighted, read and understood
3. Pay the Parent Levy to the Educator, as per the Educator Fee Schedule. I understand this amount will then be withheld from my CCS if claimed
4. Give required notice of ceasing care in accordance with the conditions of my Educator’s Fee Schedule
5. Notify the Coastwide Family Day Care Office of any changes in care requirements. Changes in circumstances such as phone numbers, place of work, address, custody arrangements, or emergency contacts need to be notified
6. The Educator seeking medical, hospital, ambulance or dental attention in an emergency for my child, the cost of which will be borne by me
7. Authorise Coordination Unit Staff to care for my child/children in an emergency situation
8. Adhere to the parent responsibilities for receiving CCS from the Federal Government
9. Personal information will be shared with authorised persons as required by law or determined if necessary by the Nominated Supervisor
10. Access MyGov to approve my enrolment notification, if claiming CCS
11. Nominate my preferred start date in the enrolment form

Please input your name here to confirm
Sending

 

X

Forgot Password?

Join Us