Winter Vacation Care – Registration Form

Vacation Care
Winter 2015
Registration Pack
Winter Vacation Care 2015 will commence on Monday 29th June 2015 and finish on Monday 13th July 2015
Vacation Care is available for all families during school holidays at our John Palmer and Riverbank centres.
Further information can be obtained on our website www.northwestcommunitychildcare.com.au
NWCC @ John
Palmer Public School
NWCC @ Riverbank
Public School
85 The Ponds Blvd,
The Ponds
25 Wentworth Ave,
The Ponds
Hours
Vacation Care: Open from 7:00am till 6:00pm
Pricing Vacation Care
First Child
$50 Per Day
Additional Child
$46 Per Day
Enrolments or changes made after June 15th
Priority of Access
Access to our centres will be based on the following criteria:
1. A child at risk of serious abuse or neglect
2. Existing bookings (current child & same sessions)
- Accounts must be up to date
3. Bookings where child of a single parent who satisfies, or
both parents who satisfy the work, training, study test.
Within this group, priority will be given to bookings where
a) Existing family enrolling an additional child (same sessions
as other child already enrolled)
b) Existing booking seeking to transfer from another centre
(same sessions). e.g. Child attending Schofields centre
seeking to move to The Ponds centre
c) Existing family seeking additional sessions
d) New families (ie. Not currently using NWCC Before
and After School Care)
4. Other bookings
PLEASE NOTE: Priority is given to children who attend the
school where the centre is located.
To make a booking
Please return the completed registration pack along
with any medical management plans, additional
information required and ACIR statement to:
[email protected]
OR
39/15 Valediction Rd,
Kings Park NSW 2148
OR
Drop it to the Team Leader at the centre
2015, will incur a fee of $10 per child
Additional Costs
JOHN PALMER
Wednesday 1st July - Rock Climbing - $38
Thursday 2nd July - Christmas in July - $5
Wednesday 8th July - Mozart to Gaga - $10
RIVERBANK
Wednesday 1st July - Mozart to Gaga - $10
Thursday 2nd July - Christmas in July - $5
Wednesday 8th July - Rock Climbing - $38
Breakfast provided until 8am
Lunch will be provided
What to Bring
- Morning and Afternoon Tea
- Hat
- Shirt/top with sleeve (i.e. NO singlets)
- Sensible Shoes (i.e. Not thongs or heels)
- Please leave valuables and electronic devices
at home
Pick Up / Drop Off
Please ensure all persons collecting and
dropping of your child bring photo
Identification. NWCC will only release
children to parents and authorised collectors
stated on the form
Specific Needs
NWCC will endeavour to meet all families
special requests. Please bring these needs to
the attention of NWCC and we will assess our
ability to meet those needs.
Northwest Community Childcare is managed by Northwest Community Baptist
Church and operates under the Northwest Community Trust
Phone 02 8678 0279 web www.northwestcommunitychildcare.com.au
Winter Vacation Care 2015
Child Details
Does your child live with Anaphylaxis?
Surname
Given Name
MALE
MEDICAL - Please Tick
FEMALE
Is your child imunised?
Is your child able to receive paracetamol?
Can your child wear sunscreen?
Does your child live with chronic asthma?
Other?
Can your child self administer medication? (Asthma and Panadol only)
Allergies?
Date Of Birth
DEVELOPMENTAL / LANGUAGE
Does your child have any developmental considerations? Please List
Child CRN (cust. Reference no.)
Do you speak English at home? Other language your child speaks?
School
CULTURAL / RELIGIOUS
Year at School
Does your child have any cultural or religious considerations? Please List
Please Tick:
Aboriginal or Torres Strait Islander decent?
Does your child have cultural dietary requirements? Please List
Can your child watch a PG rated movie?
Can photos of your child be taken?
INTERESTS
Is there anyone who is prohibited from
picking up your child?
If so, a current court order is required
What are you child’s
interests or hobbies?
MEDICAL - Please Tick
Does your child live with Anaphylaxis?
Surname
Given Name
MALE
FEMALE
Is your child imunised?
Is your child able to receive paracetamol?
Can your child wear sunscreen?
Does your child live with chronic asthma?
Other?
Can your child self administer medication? (Asthma and Panadol only)
Allergies?
Date Of Birth
DEVELOPMENTAL / LANGUAGE
Does your child have any developmental considerations? Please List
Child CRN (cust. Reference no.)
Do you speak English at home? Other language your child speaks?
School
Year at School
CULTURAL / RELIGIOUS
Does your child have any cultural or religious considerations? Please List
Please Tick:
Aboriginal or Torres Strait Islander decent?
Does your child have cultural dietary requirements? Please List
Can your child watch a PG rated movie?
Can photos of your child be taken?
INTERESTS
Is there anyone who is prohibited from
picking up your child?
If so, a current court order is required
What are you child’s
interests or hobbies?
I declare that I have read, accept and understand all information within the NWCC Parent Handbook. I declare all information I
have provided is accurate and current and will notify NWCC of any changes. I authorise the person in charge, in case of an
emergency to obtain any assistance on my behalf as my child/ren require, I agree to pay all fees and charges incurred. I
acknowledge that NWCC may obtain and exchange information with relevant parties in relation to child protection. I am
aware that my child will be observed and documentation kept while in care. I recognise that programs may change from what
is published and I accept that NWCC will not be held liable for any loss, or damage of property or injury caused whatsoever
that occurs whilst my child/ren in attendance at NWCC. I have ensured that all asthma, anaphylaxis management plans,
medication and ACIR Statements are given at time of enrolment.
Signed: ______________________________________________________ Date:
Winter Vacation Care 2015
Parent Details
Surname
Surname
Given Names
Given Names
Parent CRN (Cust. Reference No.)
Parent CRN (Cust. Reference No.)
Relationship to Children
Relationship to Children
Date of Birth
Date of Birth
Address
Address
Mobile Phone Number
Mobile Phone Number
Secondary Phone Number
Secondary Phone Number
Email
Email
Employment
Employed
Studying/Training
Employment
Looking for Work
Other
Employed
Looking for Work
Studying/Training
Other
Emergency Contacts
Surname
Surname
Surname
Given Names
Given Names
Given Names
Relationship to Child
Relationship to Child
Relationship to Child
Date of Birth
Date of Birth
Date of Birth
Address
Address
Address
Contact Number
Contact Number
Contact Number
Authorised to Collect
Authorised to Collect
Authorised to Collect
Winter Vacation Care 2015
Bookings
Please indicate which Vacation Care Centre your child/ren will be attending.
Please note that only one centre can be chosen for the duration of Vacation Care.
NWCC @ John
Palmer Public School
NWCC @ Riverbank
Public School
85 The Ponds Blvd,
The Ponds
25 Wentworth Ave,
The Ponds
Week One - 29th June 2015 to 3rd July 2015
Child’s Name
Monday
29th June
Thursday
2nd July
Friday
3rd July
Thursday
9th July
Friday
10th July
Wednesday
15th July
Thursday
16th July
Friday
17th July
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Tuesday
30th June
Wednesday
1st July
Excursion/Incursion Christmas in July
Week Two - 6th July 2015 to 10th July 2015
Child’s Name
Monday
6th July
Tuesday
7th July
Wednesday
8th July
Excursion/Incursion
Week Three - 13th July 2015
Child’s Name
Monday
13th July
Tuesday
14th July
Winter Vacation Care 2015
Rock Climbing
Excursion
Permission Note
I
give permission for my child/ren (Please insert names):
to attend the Vacation Care Excursion to:
The Edge, Castle Hill on
Wednesday 1st July 2015 or Wednesday 8th July 2015
(please delete date not applicable)
Travelling by private bus supplied by Baxters Buslines from
John Palmer Public School or Riverbank Public School
(please delete school not applicable)
to The Edge, Rock Climbing, Castle Hill
Leaving at 9:30am sharp and returning at approximately 1:30pm
Signed: ____________________________________
Date: ________________________________
Winter Vacation Care 2015
Credit Card Payment Authority
Account Name:
Card Type:
Visa
Mastercard
Card Number:
Card Expiry:
CVV:
Name on Card:
Payment Authority
Deduct payment
Yes
No
as per statement:
OR
Payment Amount:
Cardholder Signature:
Payment Frequency: