Enrolment Form

CHILDCARE/ACTIVITY GROUP ENROLMENT FORM

A parent or guardian who has lawful authority in relation to the child must complete this form. A brief explanation of lawful authority is found at the end of this form. The licensed children’s services must collect the child’s enrolment information in this form, as required in regulations 31 to 35. Some questions are required by the Regulations, and you are encouraged to answer all of the questions to assist in caring for your child.

  • Member Details
  • User Name*
  • Email Address*
  • Information About the Child
  • Family Name*
  • Given Name*
  • Usually called
  • Date of Birth*
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  • Gender*
  • Home Address*
  • Language(s) spoken in the home*
  • Child's cultural background*
  • Is the child of Aboriginal and/or Torres Strait Islander origin? (Please tick)*


  • Information About the Child's Parents or Guardians
  • Parent 1 (Primary Contact)
  • Name*
  • Address - as per child or*
  • Telephone/s
  • Home
  • Work
  • Mobile*
  • Email*
  • Does this child live with this parent?(please tick)*
  • Parent 2
  • Name
  • Address - as per child or
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Email
  • Does this child live with the parent?(please tick)
  • Guardian (if applicable)
  • Name
  • Address - as per child or
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Email
  • Does this child live with the guardian?(please tick)
  • Guardian (if applicable)
  • Name
  • Address - as per child or
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Email
  • Does this child live with the guardian?(please tick)
  • Details of People Who You Authorise to Collect Your Child.
  • Your consent is required for other people to collect the child from the children’s service on your behalf. Please list the details of those people who can collect the child in the table below. This list may be added to or changed throughout the year. In the event that the child is not collected from the children’s service and the parents or guardians cannot be contacted, this list will also be used to arrange someone to collect the child.
  • Person 1
  • Name*
  • Address*
  • Telephone/s
  • Home
  • Work
  • Mobile*
  • Relationship to child*
  • Person 2
  • Name
  • Address
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Relationship to child
  • Person 3
  • Name
  • Address
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Relationship to child
  • Person 4
  • Name
  • Address
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Relationship to child
  • Details of other persons to be notified in event of accident or illness.
  • There may be times when the child has an accident, injury, trauma or illness and the parents or guardians cannot be contacted. To deal with these situations the children’s service should notify one of the following people who are authorised to collect and care for the child after accident, injury, trauma or illness.
  • Person 1
  • Name*
  • Address*
  • Telephone/s
  • Home
  • Work
  • Mobile*
  • Relationship to child*
  • Person 2
  • Name
  • Address
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Relationship to child
  • Details of people you authorise to consent to medical treatment.
  • The name, address and phone number of any person who has lawful authority to (i) consent to the medical treatment of the child; (ii) request or permit the administration of medication to the child.
  • Person 1
  • Name*
  • Address*
  • Telephone/s
  • Home
  • Work
  • Mobile*
  • Relationship to child*
  • Person 2
  • Name
  • Address
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Relationship to child
  • Details of people you authorise to authorise the taking of children outside premises by staff members of the service.
  • The name, address and telephone number of each person who has lawful authority to authorise the taking of the child outside the premises of the service by a staff member of the service.

  • Person 1
  • Name*
  • Address*
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Relationship to child*
  • Person 2
  • Name
  • Address
  • Telephone/s
  • Home
  • Work
  • Mobile
  • Relationship to child
  • Court Orders Relating to the Child
  • Are there any court orders relating to the powers and responsibilities of the parents in relation to the child or access to the child?*
  • 1.Bring the original court order/s for staff to see and a copy to attach to this enrolment form.
  • 2. If these orders:

    a) Change the powers of a parent/guardian to:

    • Authorise the taking of the child outside the service by a staff member of the service;
    • Consent to the medical treatment of the child;
    • Request or permit the administration of medication to the child;
    • Collect the child from the service AND/OR

    b) Give these powers to someone else, please describe these changes and provide the contact details of any person given these powers:

  • Child's Medical and Health Information
  • Name Doctor/Medical Service*
  • Telephone*
  • Address Doctor/Medical Service*
  • Medicare number*
  • *Maternal & Child Health (MCH) Centre*
  • Does your child have child health book/record? (please tick)*
  • If yes, please bring into the Centre for sighting.

    Child Health record means a record that documents a child's health and development assessments and immunisations.

  • Does the child have any special needs, developmental delay or disability including intellectual, sensory or physical impairment? (please tick)*
  • If yes, please provide details of any special needs and any management procedure to be followed with the respect to the special need.

  • Does your child have any allergies or sensitivity? (please tick)*
  • If yes, please provide details of any special needs and any management procedure to be followed with the respect to the allergy?

  • Anaphylaxis
  • Has your child been diagnosed at risk of anaphylaxis?*
  • Does your child have an auto injection device (e.g. Epipen®)?*
  • Has the anaphylaxis medical management plan been provided to the service?*
  • Has a risk management plan been completed by the service in consultation with you?*
  • In the case of anaphylaxis you will be provided with a copy of the services anaphylaxis management policy. You will be required to provide the service with an individual medical management plan for your child signed by the medical practitioner who is treating your child. This will be attached to your child’s enrolment form. More information is available at www.education.vic.gov.au/anaphylaxis
  • Does your child have any other medical conditions? (E.g. asthma, epilepsy, diabetes etc. that are relevant to the care of your child?*
  • If yes, please provide details of any special needs and any management procedure to be followed with the respect to the medical condition?

  • Does your child have dietary, cultural or religious restrictions?*
  • If yes, the following restrictions apply

  • Proof of Child's Identity
  • We require a copy of the Child's Birth Certificate (Please attach a copy below OR bring in original for copying)
  • Attach Birth Certificate
  • You will need to bring in proof of address for copying (e.g.: drivers license, utility bill)
  • Child’s Immunisation Record
  • Has the child been immunised? (please tick)*
  • If yes, provide the details by

  • Attaching the Child History Statement from the Australian Childhood Immunisation Register (or bring original in for copying)
  • *Other information
  • If there is anything else that the children’s service should know about the child (e.g. excessive fears, attending other early childhood service or early intervention service, etc)
  • Sunscreen Protection
  • In line with the Anti-Cancer Council of Victoria recommendations, the children’s service suggests all children are protected by SPF 30+ sunscreen when exposed to sunlight. In conjunction with Park Orchards Learning Centre’s Sunsmart Policy we ask that each parent apply SPF 30+ sunscreen to their child prior to arrival at Occasional Care.
  • Do you give your permission for the childcare workers re-applying SPF 30+ sunscreen (which I have applied) to my child when going outside during September through and including April*
  • Declaration and Consent to Emergency Medical Treatment and Administering of Medication
  • I - a person with lawful authority of the child referred to in this enrolment form,

    • declare that the information in this enrolment form is true and correct and undertake to immediately inform the children’s service in the event of any change to this information;
    • agree to collect or make arrangements for the collection of the child referred to in this enrolment form if s/he becomes unwell at the service;
    • consent to the childcare co-ordinator or other staff member of the children’s service, seeking medical treatment for the child from a medical practitioner, hospital or ambulance service.
    • authorise the administering of medication to the child
    • authorise staff to take my child outside the service premises if necessary (e.g.: fire drill/evacuation)

    I understand that I will be responsible for any necessary expenses incurred by the Park Orchards Learning Centre.

  • I agree with all the above conditions in this section.*
  • Lawful Authority
  • Parents - All parents have powers and responsibilities in relation to their children that can only be changed by a court order. The Children’s Services Regulations 1998 refer to these powers and responsibilities as “lawful authority”. It is not affected by the relationship between the parents, such as whether or not they have lived together or are married. A court order, such as under the Family Law Act, may take away the authority of a parent to do something, or may give it to another person.

    Guardians - A guardian of a child also has lawful authority. A legal guardian is given lawful authority by a court order. The definition of “guardian” under the Children’s Services Act 1996 also covers situations where a child does not live with his or her parents and there are no court orders. In these cases, the guardian is the person the child lives with who has day-to-day care and control of the child.

  • Confidentiality of Enrolment Records
  • The Primary Nominee of this children’s service must ensure that information in this enrolment record is not divulged to another person unless necessary for the care or education of the child, to manage medical treatment of the child, where expressly authorised by the parent or prescribed in the Children’s Services Regulations 2009 (reg. 35 (1) (d-e)
  • I declare as the person with lawful authority of the child referred to in this enrolment form that the information provided is true and correct and undertake to immediately inform Park Orchards Learning Centre in the event of any change to this information.

    Privacy Statement: Park Orchards Learning Centre Inc. respects your right to information privacy. Information collected and held is kept in accordance with information privacy laws. Please contact us if you would like any further information on privacy.

  • I agree with all the above conditions in this section.*
  • Getting to Know Your Child
  • To assist the childcare staff in getting to know your child and planning the sessions could you please fill in the following information?
  • Toilet trained?*
  • Has your child been in child care before?*
  • Are there any brothers or sisters?*
  • If yes, please list them (Name, Age, Gender)

  • Are there any pets?*
  • If yes, please list them (Type, Name)

  • Does your child have any security objects?*
  • If yes, what are they?

  • Does your child have any fears or dislikes?*
  • If yes, what are they?

  • Are there any special occasions that your family celebrate or do not celebrate?*
  • If yes, what are they?

  • Does your child enjoy following activities?
  • Singing*
  • Art Activities*
  • Dancing*
  • Sandpit*
  • Outside play*
  • Puzzles*
  • Water play*
  • Getting messy*
  • Other
  • What is your child’s favourite?
  • Storybook
  • Storybook character
  • Toy
  • Game
  • Song
  • Are there any words that have a special meaning to your child that we may need to know?
  • If yes, what are they?

  • Any information you would like to share with us
  • Photographic Permissions
  • For Personal Use



  • Sharing with Other Parents



  • For Advertising Purposes


  • User Name
  • Child Safe Code of Conduct
  • I agree to the Code of Conduct*

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