Fax: 9710 0597Email: VacationCare@ssc.nsw.gov.auPh: 9710 0466

BURRANEER BAY ENROLMENT FORM APRIL 2018Name of Parent Claiming CCB:      

Child/ren’s name/s:      

Have you used Sutherland Shire Council’s Vacation Care before? Yes NoTERMS & CONDITIONS

Fee Payments In applying for enrolment, I hereby acknowledge that I am wholly responsible for all fees payable

to Sutherland Shire Council, in respect to my child/ren being in care. I understand that any fees paid are not refundable or transferable. I am aware that bookings are subject to availability and the early bird rate will not apply after the

enrolment closing date. Please Refer to the current Schedule of Fees & Charges on the Council’s Website.

I am aware that I am required to complete either my credit card details or direct debit details on the attached form.

I am aware that I am liable to pay for the days and excursions requested on this form (subject to availability) and I cannot cancel or request an exchange of days.

I am aware that I can add days and make payment at that time

Child Care Benefit & Child Care Rebate Any request for a CCB backdate can only be done up to 30 days from the end of the Vacation Care

period. I understand that I am responsible for registering for Child Care Benefit and Child Care Rebate. I acknowledge that if there is no Child Care Benefit or Child Care Rebate approval at the time of my

booking I am liable to pay full fees.

Injury or Loss to Person or Personal Property I understand that whilst every care and precaution will be taken, Sutherland Council and its staff are not

responsible for any injury, damage or loss to my child or their possessions whilst at the Centre or on an excursion.

Privacy And Storage Of InformationThe personal information that Council is collecting from you is for the purposes of the Privacy and Personal Information Protection Act 1998 (“the Act”).The information you have supplied will be stored at Council while your child is attending care and electronically for Child Care Benefit purposes. This information will then be stored in Council archives for up to 7 years.The intended recipients of the personal information are: Authorised Officers within Sutherland Shire Council A person otherwise authorised by law to inspect the records.Council is collecting this information for the purpose of maintaining accurate child-care information and parental contact details. In addition, Council may use this information for time to time in order to contact you to inform you of updated children’s services information.

OFFICE USE ONLY

File Name: Entered By:

Family Code: F0 Date Entered:

Receipt: Journal:

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Fax: 9710 0597Email: VacationCare@ssc.nsw.gov.auPh: 9710 0466

BURRANEER BAY ENROLMENT FORM APRIL 2018TERMS & CONDITIONS CONTINUED

Booking Conditions Payment will be processed or charged by close of business the day your booking is received Attendance will be refused if parent arrives at service without making payment prior Bookings received after the closing date will be charged the daily fee rate If your enrolment form is not completed your booking will not be processed until a

completed enrolment form is received. The enrolment/booking form for the current vacation care period must be completed. Copies

of previous forms will not be accepted Booking will not be accepted after 10:00am the day before care

Information For Parents If Your Child Does Not Attend Care On The Scheduled Start DateFamilies who give notice of their intention to not start care on the agreed date need to be aware of the following information provided in the Child Care Service Handbook 2014, Section 13.  In particular we draw your attention to the area of Child Care Benefit (CCB) and Child Care Rebate (CCR) which may not be payable to families.  The following is an extract from the abovementioned Handbook containing information that is relevant to this service:“A child who has not yet received care …CCB will not be paid for absences where fees are charged to reserve a place for a child who has not yet started education and care. CCB will not be paid for absences once a child has ceased education and care.However, if a child is booked in to start at your service on a particular date, and does not start on that day the family may only receive CCB for the days the child was expected to attend if the child's 42 days absences have been exhausted and the absence is an additional absence. Initial 42 days absences may not be claimed for these days".Please be aware that Sutherland Shire Council observes the above practice and that in the event your child does not start care on the booked date, CCB is not payable on the outstanding amount.If you require further clarification of this, please call the Customer Service Team on 9710 0466.

Excursions & Transport I understand that excursions may be cancelled due to low numbers and I will be credited back the

excursion cost I understand that due to numbers and staffing my child may be transported to and from another centre if

they are not attending an excursion, and I will be notified of this at the centre.

Has your child been immunised in accordance with Department of health guidelines?      

Please supply an updated immunisation statement if your child falls into one of the following categories: Child is new to the service Child has been immunised since last supplied immunisation statement

I have agreed to enrol my child/ren      in the Sutherland Council Vacation Care Program. (Names of children)

I have read and agree to be bound by the abovementioned Terms and Conditions

Print Name:       Date:      

Email Address:       Relationship to child/ren:      

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BURRANEER BAY ENROLMENT FORM APRIL 2018You must complete all the sections below:

PARENT / GUARDIAN 1 (Parent / Guardian Claiming CCB)Relationship to Child/ren      

First Name       Surname      Home Phone No       Work Phone No      

Mobile Phone No       Date of Birth      Address      

Occupation      Country of Birth      

Parent’s CRN      

PARENT / GUARDIAN 2Relationship to Child/ren      

First Name       Surname      Home Phone No       Work Phone No      

Mobile Phone No       Date of Birth      Address      

Occupation      Country of Birth      

Medicare Number:      

EMERGENCY CONTACTS - If parents unavailableEmergency Contact Contact 1 Contact 2

First Name            Surname            

Home Phone No            Work Phone No            

Mobile Phone No            Relationship To Child            

Please tick which permissions you give each contact person To collect child/ren To collect child/ren To authorise medication for child To authorise medication for child To authorise excursions for child To authorise excursions for child

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Fax: 9710 0597Email: VacationCare@ssc.nsw.gov.auPh: 9710 0466

BURRANEER BAY ENROLMENT FORM APRIL 2018CULTURAL BACKGROUND

What is the primary language used in your child/ren’s home?     

What is the cultural background of your child/ren?     

What is the cultural background of you and your partner?     

Are there any religious or cultural requirements relating to your child/ren's upbringing that you would like us to honour in caring for your child/ren?     

Are you or any of the children listed on this form Aboriginal or Torres Strait Islander background?

Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander Neither Unknown Decline to advise

WHERE DID YOU HEAR ABOUT THIS SERVICE? Our Shire Internet Have Used Before Word Of Mouth School Newsletter Library Other (Please Specify)

     

REASON CARE REQUIRED (X ONE only) At Risk / Referral (e.g. DoCS Referred) Working / Studying / Maternity Leave / Returning to work / Looking for Work Respite Care - Not Working and Not Looking for Work

Are there any Court Orders or Custody Arrangements Relating to your Child/ren?

     If Yes a certified copy needs to be supplied prior to the start of care

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BURRANEER BAY ENROLMENT FORM APRIL 2018Child 1 Child 2

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BURRANEER BAY ENROLMENT FORM APRIL 2018First Name            

Surname            Date Of Birth            

Gender            Child’s School            

Country of Birth            Child’s CRN            

Allergies#            

Special Needs            

Medical Conditions*

           

Child 3 Child 4First Name            

Surname            Date Of Birth            

Gender            Child’s School            

Country of Birth            Child’s CRN            

Allergies#            

Special Needs            

Medical Conditions*

           

* If your child has a medical condition, you will be required to provide a current medical management plan at the time of enrolling. Bookings will not be accepted until this documentation is provided. Plans will need to be updated annually from the date on the medical documentation or as changes occur to the child's condition for children returning to care and resubmitted.

# If your child has an allergy that requires medication if exposed you will be required to complete the Medical Management Plan

AUTHORISATIONSProducts

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BURRANEER BAY ENROLMENT FORM APRIL 2018

Adhesive Dressing Tape Plastic Bag For Amputation Non-Adhesive Dressing Pad Sterile Eye Pad Conforming Gauze Bandage Conforming Gauze Bandage Disposable Latex Gloves

Thermo Accident Blanket Safety Pins - Assorted Scissors - Sharp/Blunt Splinter

Forceps Sterile Eyewash Antiseptic Swabs Triangular Bandage Band-Aids/Elastoplasts

Sterile Wound Dressing First Aid Guide Forehead

Thermometer Rapaid First Aid Spray Rapaid Itch Relief Sachet Disposable Resuscitation Face

Shield First Aid Tool Box (11090)

Authorisation Details

Cancer Council Sunscreen 30+

Active: - Octyl Methoxycinamate 60mg/g- Butyl Methoxydibenzoylmethane 20mg/g

Other: - Phenoxyethanol 3mg/g- Hydroxybenzoate 4mg/g- Methylbenzylidene Camphor 30mg/g

Rid Cream RepellentActive: - 160b LN, N-diethyl m Tuoluamide (DEET)

- 20g/1 N-Octyl Dicycloheptene Dicarboximide- 10g/1 Di-N-Propylisocinchomeronate- 1g/1 Tricolsan

Panadol Colour-Free - 5ml contains 120 mg paracetamol- Free from asprin, sugar and alcohol

Ventolin - (in the event of a suspect Asthma Attack)

- 100mg Salbutamol- HFA - 134a propellant

Photography & Video UseFor developmental, educational, publication or communication, purposes at the Centre

Student DocumentationUseFor TAFE and / or University Students to observe and document information about my child for the purpose of Early Childhood Studies. I am aware that all documentation will remain confidential and only first names will be used.

I give permission for all of the above items to be used on my child/ren

Children’s Names:      

I give permission for the above items to be used on my child/ren EXCEPT the items listed below

Child’s Name Items to not be used                                            

PERMISSION FOR MEDICAL TREATMENT & AMBULANCE SERVICE InitialYes No

I authorise staff at the service to seek emergency treatment for my child from a registered medical practitioner including medical, hospital, dental and ambulance service (including ambulance transportation) should this be considered necessary.

           

Completed By:       Date:      

Signature:       Date:      

Monday 16th April 2018 - Friday 27th April 2018Please complete the sections below:

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BURRANEER BAY ENROLMENT FORM APRIL 2018

BOOKING OF DAY/S: (Please cross in the appropriate box the days you require)

Denotes Compulsory excursion/activity days Denotes Optional excursion/activity daysWEEK 1

CHILDSNAME

AGE Monday Tuesday Wednesday Thursday Friday16th April 17th April 18th April 19th April 20th April

1)                    2)                    3)                    4)                    

Week 2 Description No. Children Excursion Fee Total

PayableMonday16th April Jollybops Science Show All ages compulsory incursion       X $10.00 = $      Tuesday 17th April Future Park @ Powerhouse Museum All ages optional excursion       X $25.00 = $      

Wednesday 18th April Giant Games All ages compulsory incursion       X $7.00 = $      

Wednesday 18th April Archie Brothers Cirque Electric 10-12 year olds optional excursion       X $35.00 = $      

Friday20th April Princess & Prince Show All ages optional excursion       X $20.00 = $      

Friday20th April Bundeena Ferry & Picnic 10-12 year olds optional excursion       X $10.00 = $      

Total Fee for Excursions Week 2 = $      Yes No

If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre

You will be advised if any excursions/incursions are unavailable

** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date **** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date **

Early Bird closing date is Sunday 8th April 2017 at Midnight.

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Fax: 9710 0597Email: VacationCare@ssc.nsw.gov.auPh: 9710 0466

BURRANEER BAY ENROLMENT FORM APRIL 2018BOOKING OF DAY/S: (Please cross in the appropriate box the days you require)

Denotes Compulsory excursion/activity days Denotes Optional excursion/activity days

WEEK 2

CHILDSNAME

AGE Monday Tuesday Wednesday Thursday Friday23rd April 24th April 25th April 26th April 27th April

1)              CENTRE CLOSED

   2)                  3)                  4)                  

Week 2 Description No. Children Excursion Fee Total

PayableMonday23rd April Mini Olympics All ages compulsory incursion       X $10.00 = $      Tuesday 24th April Lollipops Play Centre 5-9 year olds optional excursion       X $22.00 = $      Tuesday 24th April Ninja Warehouse 101 9-12 year olds optional excursion       X $30.00 = $      Thursday 26th April Paper Pilots All ages compulsory incursion       X $14.00 = $      

Total Fee for Excursions Week 2 = $      Yes No

If the optional excursions/incursion are unavailable I would still like to be booked in for the days at the centre

You will be advised if any excursions/incursions are unavailable** The Early Bird Rate is $52.00 plus excursion / activity costs on bookings received before the closing date **

** The Daily Rate is $57.00 plus excursion / activity costs on bookings received after the closing date **Early Bird closing date is Sunday 8th April 2017 at Midnight.

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BURRANEER BAY ENROLMENT FORM APRIL 2018

EXCURSION PERMISSIONSChildren’s Names:      

I give permission for my child/ren (mentioned above) to participate in the following excursion/s:to Future Park at Powerhouse Museum on Tuesday 17th April 2018.The activities will include exploring interactive installations in the exhibition. I understand they will travelling by bus to the Powerhouse Museum at Ultimo and will be away from the service for approximately 7 hours.

to Archie Brothers Alexandria Wednesday 18th April 2018.The activities will include arcade games and activities. I understand they will be travelling by bus to Alexandria and will be away from the service for approximately 5 hours.

To Princess and Princes show Casula Powerhouse Friday 20th April 2018.The activity will include watching a performance presented by LOUD Theatre Company. I understand they will be travelling by bus to Casula Powehouse and will be away from the service for approximately 5 hours.

to Bundeena for a picnic and play at park and beach Friday 20th April 2018The activities will include catching ferry to Bundeena, having a picnic and time to play at the park and beach. I understand they will be travelling by Family Day Care bus to and from Cronulla then catching the ferry to Bundeena and will be away from the service for approximately 5 hours.

to Lollipops Play Centre Tuesday 24th April 2018The activities will include free play on the play equipment. I understand they will be travelling by bus to Menai and will be away from the service for approximately 5 hours.

to Ninja Warehouse 101 Tuesday 24th April 2018The activities will include various obstacle courses for the children to complete. I understand they will be travelling by bus to Wetherill Park and will be away from the service for approximately 7 hours.

A risk assessment has been finalised for all excursions and is available. There will be a 1:8 ratio on the excursion. I understand and agree that whilst every care will be taken, Sutherland Shire Council and its Staff will not be liable for injury or loss to my child/ren or their belongings.

Parent Name:       Date:      

Completed By:      PLEASE NOTE: The excursions must also be included on the booking sheets.

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BURRANEER BAY ENROLMENT FORM APRIL 2018

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BURRANEER BAY ENROLMENT FORM APRIL 2018

PAYMENT METHODS CREDIT CARD - a merchant fee is applicable on all credit card payments - See details below

Cardholder’s Name:      Card Type: Visa MasterCard American Express

Card No:      Expiry Date:    /   

Payments will automatically be deducted and an email sent advising the amount to be deducted

DIRECT DEBIT - this option is only available in advance of care date

Please use my existing Direct Debit set up for Vacation Care

Please use set up a Direct Debit for Vacation Care using the details below

Financial Institution:      Branch:      

Name on account:      BSB Number:      

Account Number:      Note - Name of account is not the type of account, i.e. Savings, Home loan; it is the name the account is under, i.e. Mr John Citizen, Mrs J. D. Citizen.

Payments will automatically be deducted and an email sent advising the amount to be deducted

Direct Debit Conditions I understand that if my Direct Debit is dishonoured by the above Institution, I will incur a fee. (see current

Schedule of Fees & Charges)

I understand if my account details change I must inform Sutherland Shire Council Children’s Services in writing.

Completed By:       Date:      

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