Emergency Care Enrolment Form

Yuma, and Welcome to Woden Valley Early Learning Centre!

Before your child starts, there are some things you can do to help ensure your child enjoys a smooth transition.

Please complete all relevant sections of your child’s enrolment form and submit it to the centre before they start. This is a regulatory requirement, and it will help educators understand your child's needs.

Child's Details

Child's Last Name *

Child's Given Names *

Date of Birth *

Gender at birth *

Child's primary address: *

Country of Birth

Primary Language

Child's Routine

Predicted drop off / pick up time?

Does your child require rest time?

YesNoSometimes

Please specify

Does your child have a comforter or a dummy? If yes, please provide details

Is your child currently:

in nappiestoilet learningneeds support when using the toiletusing toilet confidently

What are your child's current interests?

Is there anything your child is afraid of?

Is your child experiencing any traumatic events that may require mental support or may impact their behaviour while in care?

Any further comments that can help us settle your child in our care?

Parent 1 / Guardian Details

Parent 1 - Last Name *

Parent 1 - Given Names *

Parent 1 - Primary address *

Parent 1 - Date of birth *

Parent 1 - Gender

Parent 1 - Relationship to child *

Parent 1 - Phone Number / Mobile *

Parent 1 - Email address *

Parent 1 - Country of Birth

Parent 1 - Primary Language

Parent 2 / Guardian Details

Parent 2 - Last Name

Parent 2 - Given Names

Parent 2 - Date of birth

Parent 2 - Gender

Parent 2 - Relationship to child *

Parent 2 - Primary address

Parent 2 - Phone Number / Mobile

Parent 2 - Email address

Parent 2 - Country of Birth

Parent 2 - Primary Language

Do you require language support / translator?

YesNo

Which parent / guardian is the best to contact in case of emergency? *

Parent / Guardian 1Parent / Guardian 2

Emergency Care Agreement

Commencement date

Dates / period of care required *

Reason for the emergency care? *

Emergency Contacts Other Than Parents / Guardian

To protect your child’s safety, only the people authorised on your child’s enrollment form can collect your child from their early learning centre. When someone other than aparent is coming to collect your child, we must be notified beforehand, and the person will need to produce photoidentification.

All Centre visitors must follow Woden Valley ELC Visitors to the service policy and Code of Conduct for Families.

I agree to give prior notice by phone or in writing, if anyone other than the people mentioned on this form, are to collect my child from the Centre.
*

I understand that the authorised person must produce photographic identification if requested, or my child will not be released to them. *

Suppose the centre has any doubt about the authorised person's ability to care for the child or safely transport them to the parent/guardian. In that case, the responsible person in charge has the right to refuse the child's release to the person, and the parent/guardian or ACT Police may be called. *

Emergency Person 1 - Full Name

Emergency Person 1 - Relationship to child

Emergency Person 1 - Date of birth

Emergency Person 1 - Residential address

Emergency Person 1 - Phone number

The Emergency Person 1 has authority to:

Collect / deliver my child to / from the serviceGive permission for excursions out of the service or incursions to the serviceConsent to medical treatment Permit transport of my child by an ambulanceRequest / permit a medication to be given If the parent / guardian cannot be contacted, this person should be notified of an accident, injury, trauma or illness involving child

The nominated emergency person is aware of them being nominated for that position, as well as all associated responsibilities and privileges.

Emergency Person 2 - Full Name

Emergency Person 2 - Relationship to child

Emergency Person 2 - Date of birth

Emergency Person 2 - Residential address

Emergency Person 2 - Phone Number

Emergency Person 2 has authority to:

Collect / deliver my child to / from the serviceGive permission for excursions out of the service or incursions to the serviceConsent to medical treatment Permit transport of my child by an ambulanceRequest / permit a medication to be given If the parent / guardian cannot be contacted, this person should be notified of an accident, injury, trauma or illness involving child

The nominated emergency person is aware of them being nominated for that position, as well as all associated responsibilities and privileges.

Medical Information

Medicare number

Name of your family doctor / GP clinic

Phone Number

Is your child's immunisation up to date? *

YesNoUnknown

Does your child have asthma, allergies or any other medical condition? *

YesNoUnknownIn diagnostic process

If yes, please provide details

Does your child takes regular medications? *

YesNo

Does your child have any diagnosed or undiagnosed developmental delays / additional need or is identified as neurodiverse? *

YesNoIn diagnostic process

Please provide details

Dietary Requirements

Your child’s health is important to us, soour meals are nutritious and culturally balanced. If your child has a special dietary need or allergy we will attempt to accommodate their needs, or we may request you to provide alternatives.

A daily menu is displayed on the kitchen door and near the entry, as well as available on our website. The menu changes accordingly to the season and operates on a four - weekly rotation.

Does your child have any dietary requirements? *

YesNoUnknown

Is the dietary requirement...

Medically diagnosedUndiagnosedFamily preferenceFamily cultural / religious belief

Please specify your child's dietary requirements / allergies or intolerances::

Court Orders / Care Arrangements

Is your child a subject to court orders, parent orders or parenting plan relating to the powers and responsibilities of the parent in relation to the child or access to the child? *

YesNoIn process

Please provide details of the above

I give my permission to the Centre Director to discuss those details relevant to the placement of my child.

Is your child in a shared custody arrangements (not justified by the court orders)? *

YesNoIn process

If yes, please provide details regarding the care arrangements

Authorizations and Permissions

I recognise that young children play and learn in close proximity and often share toys. To prevent the spread of infectious diseases, I will not bring my child to care when sick or if I believe them to be 'coming down' with illness.If my child becomes ill during the day and I am called to collect my child from care, I will make every effort to attend or authorise another person to attend in an appropriate time. *

I understand that if it's believed that the child is critically ill or injured or at risk of serious health harm/death, the Centre has a right to call an ambulance at the first instance and then inform the family. Furthermore, in the event of any accident or illness, I authorise the obtaining, on my behalf, such medical assistance as my child may require. I also undertake to pay associated medical or ambulance fees, which may be included. *

Our educators will not administer medication without a chemist's prescription label on it stating the child’s name, product name, expiry date,the dosage required, times for administration, issuing pharmacists name and the Doctor’s name.
Unprescribed medication will NOT be given without a doctor’s letter.
Panadol, Nurofen, Tylenol, Asprin, and Dymadon are not kept in the centre and cannot be administered. *

I recognise that the Centre provides a unique nature-based program. Furthermore, I give my consent to my child participating in all aspects of the program, including but not limited to: risky play, bare feet play, messy play, fire learning, water play, stick play, tree climbing and interactions with animals. *

I give my permission to my child to attend Centre's regular outings: *

Community garden at the front of the ServiceGrassed area at the back of the ServiceRegular nature walks / excursions Emergency evacuation off site Neither of the above

I give my permission to Woden Valley Early Learning Centre to release information and documents to Government agencies, as directed by them. I give permission for the Authorised Officer to view my child's records, whilist assessing the Service against National Quality Standards. *

I give my permission to the educators to apply sunscreen to my child each day when required as per the Centre Sunsmart Policy. *

I give my permission to take and use respectful photographs of my child for the purpose of: *

Learning documentation, assessment of learning or / and display within the roomGroup learning documentation visible to other families (e.g. daily reflections / excursions / group projects)Promotional purposes (e.g. Facebook Page, website, blog)Internal training materialsExternal training materials Neither of the above

Woden Valley ELC supports open and honest communication and respectful and reciprocal relationships. I understand that I can approach the team leaders or leadership team at any time to discuss any issues or problems I may have encountered. The staff has a right to stop any conversation and remove themselves from the situation if they feel threatened, unsafe or disrespected. *

I understand that the Centre can offer only short-term emergency care as per agreement with CHS, which is free of charge. *

I agree to abide by the Centre Policies and Procedures, that are available in the foyer, on Story Park and WVELC website. *

DECLARATION
I hereby declare that the information provided is true and correct. I also understand that any wilful dishonesty or withholding of crucial information may render for refusal of care or possible termination of care. *

Sign here *

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