Mt Hawthorn Out of School Hours Centre Incorporated 1 Killarney

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Mt Hawthorn Out of School Hours Centre Incorporated 1 Killarney
Mt Hawthorn Out of School Hours Centre Incorporated
1 Killarney Street, Mt Hawthorn, 6016
197 Scarborough Beach Road, Mt Hawthorn, 6016
Postal Address: PO Box 570 MT HAWTHORN WA 6915
OSCA: 0431 815 586
MAIN HALL: 0401 342 770
[email protected]
Mt Hawthorn OSCA 2015 Enrolment Form
Parents/Guardian’s Registration Agreement
1. We have viewed Mt Hawthorn Out of School Hours Centre (hereafter called the Centre) and
consent to the enrolment of the admitting child (hereafter referred to as the child).
2. We acknowledge having read the Centre's Parent Handbook and we understand that any
changes to such will be communicated via email, parent notices or posters displayed at the sign
out point or notice board.
3. We agree to comply with the Government requirements in relation to the Centre and its service.
4. We agree that in the case of accident or injury, the Centre will attempt to contact us and where
we cannot be contacted medical care may be sought and given to the child, and we agree to
meet any expenses incurred. The medical care sought may include the calling of an Ambulance
and we agree to meet the expense of an Ambulance. In the case of an emergency as determined
by staff at the Centre we authorise the Centre to contact an Ambulance and send the child to
hospital.
5. I understand that while every care will be taken, staff and Educators are free from responsibility
for accidents and loss of property in connection with my child/children’s participation.
6. We agree to keep payment of fees as per the Centre Policy.
7. We are aware that it is our responsibility to maintain a current Family Assistance Office Income
Assessment Notice for Child Care Benefit purposes.
8. We understand that to have access to Child Care Benefit we need to meet all current Child Care
Benefit requirements.
9. We are aware that 14 (fourteen) days notice of termination of care must be given in
advance, otherwise fees will continue to be charged.
10. We are aware that fees are payable for days where allowable absences are taken.
11. We are aware that a separate enrolment form is required to be completed for each and
every school holiday program, and that each year we need to complete a new enrolment
form for Before and After School Care.
12. We understand that a system of payment for late departures operates at the Centre to cover
overtime payments due to staff. We are aware that we are obliged to drop off and pick up the
child within the opening hours of the Centre, and that late collection will result in a penalty fee
being imposed.
13. We are aware that any failure to pay due fees may result in termination of care at the Centres
option. We are aware that fees may need to be adjusted from time to time with due notice given
to parents.
14. We understand that an administration fee may be charged for unpaid fees referred to a debt
collection agency for recovery, and we will be responsible for the payment of these fees.
15. We understand that children who fall into the third priority category in the Priority of Access
Guidelines may be required to alter their days or give up their place at the Centre in order to
provide a place for a higher priority child. 14 Day’s notice will be given in the event of such a
requirement. The priorities are as follows:
 First Priority:
Children at risk of serious abuse or neglect
 Second Priority:
Children of a single parent who satisfies, or both parents who
satisfy the work / training / study test. Section 14 of the Family Assistance Act.
CRN’s required.
 Third Priority:
Any other child
16. We are aware that the child will be excluded from care at the Centre if she/he has contracted a
contagious disease or condition. We understand that the child will be accepted back into the
Centre upon provision of a “clearance certificate” for the child from a medical practitioner.
17. We are aware that if the child has not been immunised against the measles, or in the absence of
proof of earlier contact with the disease, the child will be excluded from the Centre if there is an
outbreak of measles. We understand that the child will be accepted for further care by the Centre
after receipt of medical advice that the infectious period has passed.
18. We are aware that the Centre may require the presentation of a medical certificate in the event of
the child developing a medical illness, serious injury, disability or abnormality.
19. We give permission for the child to participate in outings to places of interest in close proximity to
the Centre, e.g., walking distance (as per local walks and excursions pg 4).
(Please Circle)
20. We give ☐ / do not give ☐ permission for the child to be photographed for the purpose of
Centre experiences.
21. We give ☐ / do not give ☐ permission for the child to receive individual observation by students
on accredited training programs in the Centre.
22. We give ☐ / do not give ☐ permission for the child to receive support from a bilingual worker if
applicable.
23. We give ☐ / do not give ☐ permission for the child to move between the Undercroft/Main
Hall.
24. We agree to provide the Centre with all information regarding the health of our child and any
other information required by the Centre.
25. We are aware that if we fail to provide information correctly as required by the Centre, the Centre
will be able to terminate services forthwith.
26. We are aware that the Centre may occasionally have visitors to the Centre and have volunteers
that may assist at the Centre. We consent to our child being in the presence of visitors and
volunteers, with the Centre’s appropriate supervision.
27. We have read and support the Centre’s Philosophy which states:
Mt Hawthorn OSCA is a family focused centre which strives to meet the need for
quality care that is suitable for all children who attend the Centre. The Centre aims
to provide a safe, trusting and enjoyable environment which is appropriate for
school aged children progressing through the important stages of middle
childhood. Staff is supportive of the development of each child and encourages
children to build confidence in all areas through the planning of a variety of
activities targeting a range of physical, social, and cognitive skills.
A high value is placed on the importance of play. Independence is promoted, and
children are given the opportunity to gain a sense of responsibility and express
their freedom of choice whilst developing friendships in a comfortable, relaxed
environment.
28. The Centre reserves the right to terminate this Agreement when, in its discretion, it considers that
to do so would be in the interests of the Centre. It agrees to give the parent reasonable notice of
its intention to exercise this right and will refund any payments in credit.
29. We have read this agreement, and have received relevant information about the service offered
by this Centre for the care of:
Name of Child / Children: ____________________________________
We agree to abide by the conditions of use of the Centre and this Contract.
________________________________________
Signature of Parent / Guardian
Date: ___/___/_____
________________________________________
Signature of Parent / Guardian
Date: ___/___/_____
________________________________________
Signature for and on behalf of Mt Hawthorn OSCA
Mt Hawthorn Out of School Hours Centre Incorporated
1 Killarney Street, Mt Hawthorn, 6016
197 Scarborough Beach Road, Mt Hawthorn, 6016
Postal Address: PO Box 570 MT HAWTHORN WA 6915
OSCA: 0431 815 586
MAIN HALL: 0401 342 770
[email protected]
The following enrolment information will be treated with confidentiality. It is the responsibility of the
parent/ guardian to update this information on an on-going basis, and to be familiar with the OSCA
program.
ALL SECTIONS MUST BE COMPLETED. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
I, ______________________________, understand it is my responsibility to update enrolment information
as necessary, and familiarise myself with the activities and outings of the OSCA program.
________________________________________
Signature of Parent / Guardian
Date: ___/___/_____
Parent / Guardian Details
Full Name of Mother / Guardian:
Address:
Home Ph.:
Work Ph.:
_____________________________
DOB: ___/___/_____
_______________________________________________________________________
_______________________
Mobile:
______________________________
_______________________
Email:
______________________________
Work Name & Address:
Occupation:
Language/s spoken:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Full Name of Father / Guardian: _____________________________
DOB: ___/___/_____
☐ As per Mother
Address:
_______________________________________________________________________
Home Ph.:
_______________________
Mobile:
______________________________
Work Ph.:
_______________________
Email:
______________________________
Work Name & Address:
Occupation:
Language/s spoken:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Person Responsible for Payment of Fees/ Registered to Claim Child Care Benefit (CCB)
Name:
______________________________
Address:
_______________________________________________________________________
Parent CRN: _______________________
Phone:
______________________________
(To claim reduced fees to obtain your CRN please contact the Family Assistance Office on 13 61 50)
Childcare Benefit Information
I would like to claim Childcare Benefit in the form of: (please tick one option)
☐ Lump sum payment end of financial year (register with FAO)
☐ Reduced upfront
☐ I do not wish to claim Childcare benefit
Child Details
Child 1: _______________ DOB: ___/___/___ CRN: ______________ SEX M ☐ F ☐ YEAR: ___ CLASS: ___
Child 2: _______________ DOB: ___/___/___ CRN: ______________ SEX M ☐ F ☐ YEAR: ___ CLASS: ___
Child 3: _______________ DOB: ___/___/___ CRN: ______________ SEX M ☐ F ☐ YEAR: ___ CLASS: ___
Child 4: _______________ DOB: ___/___/___ CRN: ______________ SEX M ☐ F ☐ YEAR: ___ CLASS: ___
Reason For Care
COPIES ATTACHED:
Birth Certificates
Y☐N☐
Immunisation Certificates Y ☐ N ☐
☐ Child at risk of serious neglect or abuse
☐ Child of a single parent, or parents who are both
undertaking work, training, or study
☐ Any other child
For Custody Arrangements
Are there any Court orders relating to the guardianship, custody or access to the child(ren)?
If YES please provide details and supply OSCA with copies:
Y☐N☐
__________________________________________________________________________________________
Special Needs, Allergies & Medical Information
Please detail any special needs, allergies or medical information about your child(ren):
__________________________________________________________________________________________
Do you have any Action Plans which you use to deal with these? Please provide details and attach a current copy:
__________________________________________________________________________________________
* Please note if you wish Centre staff to administer medication you must complete an Authority to Administer
Medication form.
Adults authorised to collect child(ren) (other than Guardians)
Staff will not release child(ren) to persons other than those listed below, or to persons aged under 18 years.
Contact Numbers
Name and Address
Relationship
Home
Work
Mobile
Contact in
Emergency
?
☐
☐
☐
☐
Parent’s Declaration
☐ In the event of an emergency involving an accident or illness, I give permission for medical attention to be
sought for my child/ren and state that I will pay for any expenses incurred for treatment and transport of my
child/ren.
☐ I give permission for my child/ren to participate in local area walks and activities as stated in the program.
☐ I agree that my child/ren can be in OSCA photos that will only be used within the Centre.
☐ I give permission for Centre staff to administer sunscreen to my child.
Name: _____________________
Signed: ____________________
Date: ___/___/_____
PLEASE FILL IN THE TABLE BELOW IF YOU WOULD LIKE TO BOOK A PERMANENT PLACE IN EITHER
BEFORE OR AFTER SCHOOL CARE.
CHILD’S NAME
MON
TUES
WED
THU
FRI
BSC
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ASC
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BSC
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ASC
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BSC
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ASC
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BSC
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ASC
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