KIDS WORLD ENROLEMENT FORMS

Confidential and Subject to Approval by Supervisor All sections must be completed before a child can be enrolled. Please notify us promptly of any changes. CHILDRENS DETAILS:

How Many Children would you like to enroll?*

Child Name 1*

Birthday*

Gender*

Male
Female

Child Name 2*

Birthday*

Gender*

Male
Female

Child Name 3*

Birthday*

Gender*

Male
Female

Child Name 4*

Birthday*

Gender*

Male
Female

Child Name 5*

Birthday*

Gender*

Male
Female

Child Name 6*

Birthday*

Gender*

Male
Female

PARENT/GUARDIAN 1- First and Last Name*

Address

Street Address

Gender*

Male
Female

Mobile Number:*

Work Phone Number:

Home Phone Number:

PARENT/GUARDIAN 2

Gender

Male
Female

Mobile Number:

Work Phone Number:

Home Phone Number:

EXTRA EMERGANCY CONTACTs (Name of 2 people who may be contacted any time if parent/guardians unavailable, optional)

Full Name

Phone

Full Name

Phone

AUTHORISATION TO COLLECT YOUR CHILD/REN We require you to provide the names of the persons authorised to collect your children from the Centre. Please note that we will not allow any person to collect your children other than those listed below. Any change will only be accepted by written authority by the parent signing below. Please include parent’s names on the list.

Full Name

Relation to Child

Full Name

Relation to Child

Full Name

Relation to Child

FAMILY DOCTOR

Name:

Address

Street Address

Contact Phone Number

Medicare Number

Are there any medical or physical conditions from which your children suffers that need to be brought to the attention of the Supervisor? Does your child have a disability? Do we need to pay attention to any particular need or behaviour? Please give details:

Details:

We regret that we are unable to care for sick children or children with contagious illnesses.

TOILET TRAINING - is your Child/ren toilet trained?*

No
Yes

What stage are they?*

CONDITIONS By enrolling my children I agree to the following conditions: 1. Children are only accepted into the crèche from 6 weeks of age. 2. I am willing for my child/ren to participate in all activities offered in the crèche. I agree it is my responsibility to familiarise myself with the program and to advise the Centre in writing if I do not wish my child/ren to participate in a particular activity. 3. In the event of accident or illness suffered by my child/ren, the organisers of the Centre Crèche are authorised to obtain, on my behalf, such medical assistance as my child/ren may require and I agree to reimburse the organisers for any expense incurred. 4. Although every care will be taken, Centre Staff are free from all responsibility for accidents or loss of property in connection with any child’s participation. 5. The Centre reserves the right to exclude children from the Crèche for misbehaviour that is deemed inappropriate. NOTE: in the event of suspension or expulsion from the Crèche, it is the parents’ responsibility to have the child collected immediately. No monies will be refunded for that session. 6. The Centre reserves the right to refuse any child or person entry to the Crèche. 7. COVID-19 I understand that my child/ren maybe part of a random temperature checked on entry and understand that if they exceed the 38 degrees, they will not be able to enter. You child will have two readings.

Consent*

DECLARATION

I declare that the information above is complete and accurate, and I have read, understood and agree to the conditions outlined above.

I understand and agree that all times my child/ren shall be at my own risk and I will not hold the Company, the centre or its staff liable for any personal injury which may result to my child or loss of property except for any liability by the Company if it fails to render its services with due care and skill or supplies any material in connection with those services which is not reasonably fit for the purpose for which they are supplied.

Electronic Signature for Parent/Guardian*

I understand by typing in my name and pressing submit, that the information is true and correct.

Signature

World Gym Burpengary | 159-161 Station Road, Burpengary Q 4505 | P 3053 3170 | E: reception@worldgymburpengary.com.au