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Online OSHC Enrolments

Step 1 of 13 - CHILD DETAILS

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Welcome to the YLV OSHC Online Enrolment Form v.2019
Youth Leadership Victoria would like to welcome your family in joining us!

Please fill out all mandatory fields (marked with * ) as they are legally required before your child can attend our programs.
Do you have a child/children currently enrolled with YLV?*
- Yes
- No
Please enter their name(s) below (First/Last):*
CHILD DETAILS
Given name(s):*
Middle name:
Surname:*
Name usually called:
Date of birth:*
Date Format: DD slash MM slash YYYY
Gender:*
- Male
- Female
Does your child identify as Aboriginal and/or Torres Strait Islander?*
- Yes
- No
Name of School your child attends:*
Other - Name of school (not on list):*
Name of YLV OSHC center you are enrolling your child into:*
Centrelink Reference Number (CRN):
Please note: Parent and child have their own individual CRN number
Child’s home address:*
Child lives with:*
DAYS OF ATTENDANCE
Please note: Your bookings may be subject to availability.
Please select from the options below:*
- My child will be attending on a casual basis
- My child will be attending on a permanent basis
- I'm just enrolling my child for now (and will make a booking at a later date)
Before school care:
Please select where applicable
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
After school care:
Please select where applicable
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Vacation Care:
Please note, you will need to fill out a separate vacation care booking form as dates are specific to each program (a link will be provided at the end of this form).
- Vacation Care
Child’s start date:*
Date Format: DD slash MM slash YYYY

CULTURAL CONSIDERATION
Language spoken at home:
Ethnicity:
Religion:
Is the Child of Aboriginal or Torres Strait Islander Descent? (Please choose)*
- Yes
- No
Please outline any cultural practices you would like followed:
Please outline the Child’s religious background and if relevant any religious practices you would like followed:
Religious celebrations:

MEDICAL INFORMATION
Medicare Number:
Medicare Expiry Date:
Date Format: DD slash MM slash YYYY
Number of child on card:
Please outline any dietary restrictions or considerations e.g. like and dislikes. (Details of allergies etc. will be requested in the Medical section of the form):
Child’s Registered Medical Practitioner or Service Details:
Service Name:*
Practitioner’s Name:*
Contact Numbers:*
Address:*
Child’s Registered Dental Practitioner or Service Details:
Service Name:
Practitioner’s Name:
Contact Numbers:
Address:
Private Health Cover:
- Yes
- No
Private Health Fund Name (if applicable):
Private Health Care Membership Number (if applicable):
Ambulance Cover:
- Yes
- No
Does your child have an allergy?*
- Yes
- No
Please describe the type of allergy your child has, allergens or substances that cause an immune system reaction in your child, and if your child has atopy (genetic tendency to develop allergic diseases).
Please use provide as much detailed information as possible.
Does the child have any specific health care needs or conditions, including ASTHMA, ALLERGIES or ANAPHYLAXIS?*
If yes, please provide a medical management plan, which the child’s medical practitioner has prepared.
The Plan should include:
- • A photo of the child
- • If relevant, state what triggers the medical condition, allergy or anaphylaxis
- • First aid needed
- • Contact details of the doctor who signed the plan
- • When the Plan should be reviewed.
- Yes
- No
Upload medical management plan here, or alternatively you can provide a copy to the program coordinator.
(Maximum file size is 5mb)
Does the child have any dietary restrictions?*
- Yes
- No
Please detail dietary restrictions below:
Medication Information:
Medication will only be administered if it is in the original container with the original label and instructions that can be clearly read and before the expiry or use by date. Additionally, if the medication has been prescribed by a medical practitioner:
- • The label must contain the child’s name and
- • Parents must provide any verbal or written instructions provided by the medical practitioner.
Education and Care Services National Regulations Regulation 95

Any medication, including non-prescription medication like paracetamol, must be authorised by parents or an authorised nominee on our “Administration of Authorised Medication” form.
Education and Care Services National Regulations Regulation 93
Parent 1 Signature*
Parent 2 Signature
Do you authorise the Nominated Supervisor or another educator at the service to seek medical treatment from a registered medical practitioner, hospital or ambulance service?*
- Yes
- No
Parent 1 Signature*
Parent 2 Signature
Do you authorise the Nominated Supervisor or other educator at the service to seek dental treatment from a registered dental practitioner or service in the event of an emergency?*
- Yes
- No
Parent 1 Signature*
Parent 2 Signature

IMMUNISATION DETAILS
I have chosen NOT to have my child immunised.*
- Yes (I have chosen NOT to have my child immunised)
- No (I have chosen to have my child immunised)
Are your child’s immunisations up to date?
- Yes
- No
Please provide a copy of your child’s Immunisation History Statement provided by Medicare, or alternatively you can provide a copy to the program coordinator.
(Maximum file size is 5mb)
Do you authorise the Nominated Supervisor or other educator to transport the child in an ambulance in the event of an emergency?*
- Yes
- No
Parent 1 Signature*
Parent 2 Signature
Please be advised:
If the Child is diagnosed with asthma or anaphylaxis and an emergency occurs, the Nominated Supervisor or other educators may administer emergency first aid without making contact. Educators will notify the child’s parents and/or emergency services as soon as possible.
Education and Care Services National Regulations Regulation 94.
Parent 1 Signature*
Parent 2 Signature

DEVELOPMENTAL INFORMATION
Please provide us with any other information we should know about your child (For example, favourite activities, fears, special words (please translate if applicable), toileting and sleeping practices etc.)
TRANSITION TO SCHOOL
Do you give the service permission to exchange information with the school to assist your child transition to school?
- Yes
- No
Name of School
Parent 1 Signature
Parent 2 Signature
FAMILY INFORMATION
Does the child have any siblings? If so, please provide their names and ages.
Does the child have any other close relations attending the school? E.g. cousins. If so, please provide their names and ages.

CHILD ROUTINE (Optional)
Please add details of your child's routine where applicable
E.g. 10:00am - Get picked up
TIP: Use the + Symbol to add multiple entries to the list
Time / Routine:

PRIMARY PARENT (LINKED TO CENTRELINK) / BILLING ACCOUNT HOLDER
NOTE: The Primary Parent is the parent who is linked to Centrelink (usually the parent with the lower income).
Parent Given Name:*
Parent Given Name:*
Parent Surname:*
Address:*
Phone Number (Home):
Phone Number (Mobile):*
Phone Number (Work):
Parent Date of Birth:*
Date Format: DD slash MM slash YYYY
Parent 1 Email address:*
Note: This email address will be used for confirmation of enrolment
Relationship to child:*
Parent Centrelink Reference Number (CRN):
Country of Birth:*
Please provide any relevant cultural background details:
Does the child live with you?*
- Yes
- No
Occupation:*
Place of employment:*

SECONDARY PARENT
Parent Given Name:
Parent Surname:
Address:
Phone Number (Home):
Phone Number (Mobile):
Phone Number (Work):
Parent Date of Birth:
Date Format: DD slash MM slash YYYY
Parent 2 Email address:
Relationship to child:
Parent Centrelink Reference Number (CRN):
Country of Birth:
Please provide any relevant cultural background details:
Does the child live with you?
- Yes
- No
Occupation:
Place of employment:

COURT ORDER
Are there any court orders, parenting orders or parenting plans relating to the powers, duties and responsibilities or authorities of any person in relation to the child or access to the child?*
- Yes
- No
Please provide all relevant documentation and paperwork
(Maximum file size is 5mb)

Please note that without this documentation we cannot legally enforce the Order/s.
Are there any other court orders relating to the child’s residence or the child’s contact with a parent or other person?*
- Yes
- No
Please provide all relevant documentation and paperwork, or alternatively you can provide a copy to the program coordinator.
(Maximum file size is 5mb)

Please note that without this documentation we cannot legally enforce the Order/s.

First Emergency Contact
There may be times or situations where your child has had an accident, injury, trauma or illness and Parent/s cannot be reached or are unable to collect their child. To deal with these circumstances the service will inform the following person to collect and care for the child. This person must live a maximum of 30 minutes from the service and must provide identification when collecting the child.

Please obtain the person’s consent before listing them as an emergency contact
Full Name:*
Relationship to child:*
Address:*
Phone Number (Home):
Phone Number (Mobile):*
Phone Number (Work):
Email address:*
Can this person be contacted to give consent for medical treatment or to authorise for a nominated supervisor or educator to administer medication to the child in the event that you cannot be contacted?*
- Yes
- No
Parent 1 Signature:*
Can this person be contacted to give consent for educators to take the child outside the service’s premises in the event that you cannot be contacted?*
- Yes
- No
Parent 1 Signature:*

Second Emergency Contact
Full Name:*
Relationship to child:*
Address:*
Phone Number (Home):
Phone Number (Mobile):*
Phone Number (Work):
Email address:*
Can this person be contacted to give consent for medical treatment or to authorise for a nominated supervisor or educator to administer medication to the child in the event that you cannot be contacted?*
- Yes
- No
Parent 1 Signature:*
Can this person be contacted to give consent for educators to take the child outside the service’s premises in the event that you cannot be contacted?*
- Yes
- No
Parent 1 Signature:*

CHILD CARE SUBSIDY (CCS)
Child Care Subsidy will be paid directly to the Service to reduce the fees families pay. To claim Child Care Subsidy (CCS) Families must meet eligibility requirements which include:
You and/or your partner must care for your child at least 2 nights per fortnight or have 14% care?
- Yes
- No
2. Are you liable for fees for care provided at an approved child care service?
- Yes
- No
3. Do you meet residency requirements?
- Yes
- No
4. Does your child meet immunisation requirements?
- Yes
- No
5. Have you completed the Child Care Subsidy assessment on the myGov website?
- Yes
- No
Have you received confirmation about your Child Care Subsidy?
- Yes
- No
Please Note:
Please Note: If you need assistance with filling out this form, please speak to the OOSHC Co-Ordinator who will be happy to help. Please ensure that if any details change, you notify the Service immediately.

ENROLMENT AGREEMENT
PLEASE READ THE FOLLOWING AGREEMENT CAREFULLY BEFORE SIGNING. PLEASE ASK IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU ARE UNSURE OF.

Please check the following items to authorise:
Health and Safety
I/We give permission for this child to: Participate in outings to places of interest (permission slip will have to be signed before allowing your child to leave the Service)*
- Yes
- No
Have SPF30+ sunscreen applied prior to sun exposure (If not, please provide a letter releasing the Service of any Liability)*
- Yes
- No
Have Band-Aids or sticking plasters applied when necessary*
- Yes
- No
Have staff apply Insect Repellent (supplied by parents)*
- Yes
- No
PHOTOGRAPHY & VIDEO
For photos and video footage to be taken of my/our child for Service use and staff training purposes (Footage will not leave Service)*
- Yes
- No
For photos and video footage of my/our child to be used in Learning Stories, and to be shared with other families that attend the Service*
- Yes
- No
For photos and video footage of my/our child to be used for student training purposes (Photos and video footage may leave the Service for students to present to lecturer and class for viewing and marking)*
- Yes
- No
For photos and video footage of my/our child to be used on Service website, social media and other internet purposes, such as advertisement and used in organisation’s resources*
- Yes
- No
Do you ONLY give permission for photos and video footage of your child to be taken for your own personal viewing and to receive copies*
- Yes
- No
Please tick box to confirm you have read each point.*
- I agree to inform the Service in writing immediately of any changes to the above information.
- I agree to keep my fees paid up to date and understand that my child’s position at the Service will be in jeopardy if my fees are not kept up-to-date. I understand that all booked days are paid for even when my child is absent due to sickness or on holidays.
- If I am unable to collect my child by closing time I will organise for one of the people listed as authorised contacts to collect my child prior to closing time. I am aware that if my child has not been collected by closing time, and if I am unable to be contacted, those persons nominated as authorised contacts will be called by Service staff to collect my child.
- I agree to pay a late fee of $15.00 per 15-minute block or part thereof after closing time. In the event that a child is left at the Service for over an hour after closing and Service staff have been unable to contact anyone to collect the child, we will notify The Department of Family and Community Services and may be required to take the child to the local Police Station to await your arrival. A note will be left detailing the child’s whereabouts.
- I agree to bring my child to the Service with sunscreen applied and give permission for staff to reapply sunscreen throughout the day. (If your child has sensitive skin and would prefer they use their own sunscreen please bring a spare tube to remain at the Service - clearly labelled with your child’s first and last name).
- I authorise the staff to administer a single dose of paracetamol (Panadol) appropriate to the child’s age in the event of a high temperature in an emergency after staff have attempted to organise someone to collect my child and have exhausted every other option. Please note that this does not mean your child can stay at the Service, they still need to be collected.
- I give permission for prescribed medication to be administered by Service primary contact staff upon my authorisation on the Service’s medication form. I understand that if details are filled in incorrectly or left blank or if the medication does not meet the standards of the Service’s policy the medication will not be given unless, in the case of missing or incorrect details I can be contacted to authorise the missing details. I agree to inform the staff both verbally and in writing of the need for medication for my child. I understand that non-prescription medication will not be given by staff unless it is accompanied by a current (within 6 months) dated Doctors letter stating the name of and reasons for the medication and only then if the Director deems the child well enough to attend Service.
- I give permission for my child to be observed by the Educators of the Service and students supervised by the Educators. I give permission for my child to participate in programs organised by practicum students under the supervision of an Educator. I am aware that confidentiality is always respected and that students will not be left with children without an Educator present.
- I have read the Parent Handbook and am familiar with the Service’s Policy Manual located in the OSHC room. I agree to follow, support and abide by these Policies and am aware that staff members are available to discuss with me any policies that I do not fully understand. I know that if I have any suggestions that I am able to make this suggestion in person to a staff member or anonymously in the suggestion box.
- I am interested in being a part of a Parent Committee that meets occasionally to update policies, etc.
- I, or someone I know has a skill they could share with the children.
- I understand the commitment that I am undertaking and my responsibilities to the Service.
Signature:*
Name:*
Date*
Date Format: DD slash MM slash YYYY
Privacy Disclaimer
We acknowledge and respect the privacy of its clients. The enrolment information that is collected assists us to meet our legislative obligations and to provide the best level of education and care for your child. By completing this form, you have consented to this information being collected. The information will be used by educators/staff members and relevant government authorities. You have the right to access and alter personal information concerning yourself or your child in accordance with the Privacy Act 1988 and our Privacy and Confidentiality Policy.
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Time / Routine:

Step 1 of 13 - CHILD DETAILS

Welcome to the YLV OSHC Online Enrolment Form v.2019

CHILD DETAILS

DAYS OF ATTENDANCE

CULTURAL CONSIDERATION

MEDICAL INFORMATION

Child’s Registered Medical Practitioner or Service Details:

Child’s Registered Dental Practitioner or Service Details:

Medication Information:

IMMUNISATION DETAILS

Please be advised:

DEVELOPMENTAL INFORMATION

TRANSITION TO SCHOOL

FAMILY INFORMATION

CHILD ROUTINE (Optional)

PRIMARY PARENT (LINKED TO CENTRELINK) / BILLING ACCOUNT HOLDER

SECONDARY PARENT

COURT ORDER

First Emergency Contact

Second Emergency Contact

CHILD CARE SUBSIDY (CCS)

Please Note:

ENROLMENT AGREEMENT

Health and Safety

PHOTOGRAPHY & VIDEO

Privacy Disclaimer

**** Form Submission Notice ****

Form Submission Notice