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KefKidz Enrolment Form

KefKidz Enrolment Form

 

 

  > > Holiday Programs Enrollment Form | טופס הרשמה לקייטנה
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     SPRING 2017

 

To ensure your place and discounted fee, this form must be received by 10.9.2017 with full payment details.

CHILD'S PERSONAL DETAILS

Last Name Given Names
Gender Date of Birth
School Grade (in 2017) Indicate correctly for grouping/safety
Swimming 

Indicate correctly for grouping/safety

Family Centerlink CRN

Child CRN Write N/A if not claiming government subsidies
Favourite activity/excursions
 
MEDICAL AND SPECIAL NEEDS

Doctor's Name & Phone

 

 

Medical Conditions: Does your child have any specific healthcare needs, including any medical conditions or allergies (including anaphylaxis)?
No Yes >

If Yes -

(1) please specify:

      (2) A Risk Minimisation Plan must be returned to our office (youth@hs.org.au) no later than a week prior to the program. Note: Medicine is to be handed into our office daily clearly labeled with instructions

Dietary requirements: Does your child have any known dietary restrictions?
No Yes > If Yes -

 

 

(1) please specify:  


 

(2) A a Risk Minimisation Plan must be returned to our office (youth@hs.org.au) no later than a week prior to the program

Child Special Needs/Difficulties (Disability): Does your child have special needs?
No Yes > If Yes -

(1) please specify:

      (2) A Special Needs Communication Form

 

must be returned to our office (youth@hs.org.au) no later than a week prior to the program.

 

 

Personal Aid:
We welcome children with additional needs and offer every child a supported and inter-graded environment. We can offer your child a personal aid or additional care (at no extra cost to you). Help us be prepared to offer your child the best care and safety, by keeping us fully informed. Failure to do so may affect the safety of our children and your child's attendance.

Does your child require (or may require) a personal aid or additional care?
No Yes Unsure > If Yes -

To be accepted, your child must also be registered (for funding purposes) with JCAAA, visit: www.portphillip.vic.gov.au/jcaaa.htm

 

PARENT DETAILS

Mother Father
Surname Surname
Given Names Given Names
Date of Birth  Date of Birth
Address Address
Suburb Postcode Suburb Postcode
Phone Home Work Phone Home Work
Mobile  Mobile
Email Email
Country of Birth Country of Birth
Main Language Main Language
Parents Marital status Rabbi/Officiator
Custody/Access Arrangements Legal docs must be provided
 
 

OTHER PERSONS AUTHORISED TO COLLECT / IN CASE OF EMERGENCY

I/We consent for the people listed as parent/guardian/person with parental responsibilities or authorised person/s below to give permission for medical treatment, administration of medication, sign incident reports for my child and give permission to an educator to remove my child from the program for excursions or medical treatment from a registered medical practitioner, hospital or ambulance service.

Name Phone
Name Phone
Name Phone
 
 

ENROLMENT

DETAILS | Spring Holiday Program 2017

 

 

SELECTED YOUR DAYS
3 days during the week must be selected for this enrolment to be accepted

 Week 1:

Monday 3 July - FULL, will be added to waiting list

 Tuesday 4 July

 Wednesday 5 July

 Thursday 6 July

 Friday 7 July

 

 Week 2:

 Monday 10 July 

 Tuesday 11 July - FULL, will be added to waiting list 

 Wednesday 12 July - FULL, will be added to waiting list 

 Thursday 13 July

 Friday 14 July


Please review carefully the days you have selected before submitting this form. If changes need to be made later, we cannot guarantee them and they will all be subject to availability.

Extended Hours Mon-Thu (limited places): Before Care, 8-9:30am After Care, 4:30-6pm

 
 
FEES & PAYMENT DETAILS

Includes all excursions, activities and food

Early Bird Special - enrolments received by 12/6/2017:

Full Week: $395 / Up to $197.50 AFTER 50% Rebate 

Normal Fee:
Full Week: $430 / Up to $215 AFTER 50% Rebate

Daily: $90 / Up to $45 After 50% Rebate (min 3 days)

Huge Government Subsidies available - Child Care Benefit & 50% Child Care Rebate - click for details (confirmation must be received 1 week before start of program to be applied)

Cancellation Policy: No refunds/credits for future programs will be issued for any absences or cancellations after 12/6/2017. The full amount will still be charged.


Bill to: Other's Name Other's Address

Please charge the amount of:

I hereby authorise to charge the full amount or the full amount less CCB/CCR if confirmation for CCB/CCR has been obtained latest one week prior to the program; and I further authorise to charge a minimum of $100 non-refundable deposit per week at time of enrollment, with the balance charged not prior to 2 weeks before commencement of program.

Payments via Credit Card only, processed by our admin service, Child Care Central (redPay) or our office.

Credit Card details:

Name on Card Card Number Expiry Date CVV

 
 
KEF KIDZ T -SHIRT OR DER

For safety reasons we require all children to wear a current KefKidz t-shirt every day. If you don't have one or wish to purchase a new one, please indicate

I would like to order (specify quantity) Child's t-shirt size:

I authorise to charge my (above) Credit Card for the t-shirt(s), to be collected on the first day of my child's attendance/

 
 
PERMISSION/DECLARATION

1. Accidents: in the event of illness or injury to my child whilst attending the Holiday Program of Lamdeni School Inc: I authorise the coordinator or staff member(s) in charge of my child, where it is impractical to communicate with me, to seek and obtain emergency, medical, hospital or ambulance attention or service on my behalf as may be deemed necessary.

2. Excursions/Transport: I give permission for my child to be transported and participate in all activities and excursions (including swimming) organised as part of the program.

3. Privacy: I give permission for my child's photographs/videos to be used for promotional purposes - including but not limited to Facebook, Instagram, emails, flyers and billboards.

4. Charges: I/We further authorise Redbourne Business Services P/L t/as Child Care Central ACN 095 164 588 (User ID 314011) to debit my/our account at the Financial Institution identified above through the BECS in accordance with the above payment details (service charge may also apply) and as per the Child Care Central Service Agreement and Hamerkaz Shelanu/Lamdeni School’s terms & conditions which I/we have received/read and understood.

5. Grouping: I understand that for safety and educational reasons my child will automatically be placed in his/her respective division, streamed according to school grades (see main page). In exceptional circumstances, should I have a request for change, I will notify KefKidz in writing ( office@hs.org.au ) no later than 2 weeks prior to the program, and I understand that my request will only accommodated subject to activity type and availability.

 
Comments
 
Confirmation to be sent to email:
 

NEW GOVERNMENT REQUIREMENT: IMMUNISATION

I understand that as per government regulations, I will supply a copy of my child's immunisation record to youth@hs.org.au, and understand that this is a mandatory requirement before acceptance into the Holiday Program.

I certify that all the above information is true and correct,
and agree to Lamdeni's terms and conditions as per Policy Book (copy available at our office).

Parents/Guardian's Signature (Required)
(Signature must be applied on form in our office on or before first day of program)

 

Thank you for enrolling your child
at KefKidz Holiday Program!

 

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