School Holidays Enrolment

If you have any difficulties filling out the form, please come to our center or call us at 9547 2555 and our friendly staff will help you!

Child's Details

Child First Name

Child Last Name

Child Gender

Child Date of Birth

Aboriginal or Torres Strait Islander?

Child Address

Child Suburb

Child State

Child Postcode

Allergies

Anaphylaxis

Asthma

Diabetes

Dietary Restrictions

Medical Conditions / Healthcare Needs

Please provide details of any medical conditions, allergies, healthcare needs and dietary restrictions below (Please clearly specify restrictions)

Is there any other information that would assist staff with caring for your child?

Restricted Access Details

Is there any court order / restraining orders / family law orders involved with child?

Details of court order

Parent/Guardian Details

Parent / Guardian #1 First Name

Parent / Guardian #1 Last Name

Relationship to Child

Does Parent / Guardian #1 live at the same address as child?

Please provide address of Parent / Guardian #1 (if different from child)

Email of Parent / Guardian #1

Mobile of Parent / Guardian #1

Parent / Guardian #2 First Name

Parent / Guardian #2 Last Name

Relationship to Child

Does Parent / Guardian #2 live at the same address as child?

Please Provide Address of Parent / Guardian #2 (if different from child)

Email Address of Parent / Guardian #2

Mobile of Parent / Guardian #2

Emergency Contact Details

To be contacted in case Parent/ Guardian #1 or #2 cannot be contacted

Emergency Contact Full Name

Emergency Contact Street Address

Emergency Contact Mobile Number

Does this Emergency Contact have lawful authority from you to:

Collect this child from the service

Request or Permit the administration of medication to this child?

Consent to medical treatment of this child?

Authorise staff to take child outside of the service premise?

Details of Additional People Who Can Collect This Child

Person #1 Full Name

Person #1 Address

Person #1 Mobile Number

Person #2 Full Name

Person #2 Address

Person #2 Mobile Number

Details of Medical Practitioner

Name of Family Doctor / Medical Practice

Doctor / Practice Contact Number

Doctor / Practice Address

Child's Medicare Number (if available)

Details of Cultural Background

Cultural Background(s) of Child / Parents

Language(s) spoken at home

Claiming CCS

Important! To claim the child care subsidy, this section must be completed. If no information is completed here, you will be charged the full fee of our program. If you are claiming CCS, parents name and gender are still required.

Parent's Full Name for Child Care Subsidy

Parent's Gender

Parent's Date of Birth

Parent's CRN Number

Child's CRN Number

Parent Declarations

Please state who is giving declaration

Is Parent #1 or Parent #2 the one who is signing the "Parent Declarations" below

If answered OTHER above, please provide your full name, mobile number and email

I Authorise Springvale Indoor Sports to:

Pre-Planned Excursions

Take my child on Regular Pre-Planned Excursions (Back of the Centre 50m away from building)

Medical Services

Call Medical Services and Transport my child to Hospital by Ambulance in case of Illness/Accident (I agree to pay all cost associated)

Administer Medication

Administer Medication (if required)

Photograph

Take photograph of my child(ren) to use in social media marketing

Springvale Indoor Sports