SECTION A. YOUR CHILD’S DETAILS
If yes, please provide copy of schedule.
If no, please provide a current certified copy of the child's exemption status.
Please note: New legislative reforms from January 1st, 2016 requires parents to show the current immunisation status of their child or a certified exemption which explains why their child has not been immunised. This information must be presented on the correct ACIR forms. This is a requirement needed to be able to allow the enrolment of children in preschools and child care centres Australia-wide. A copy of these documents must be held on site in the child's file before the child can attend their first day of preschool.
If yes to any of the above, a medical management plan is required from your doctor.
SECTION B. PARENT/CARER DETAILS & INCOME INFORMATION
Parent/Carer (1)
Parent/Carer (2)
SECTION C. EMERGENCY CONTACT DETAILS & AUTHORISATIONS TO COLLECT (Other than parents/guardians)
Emergency Contact: Is Someone who can be contacted when we cannot get hold of parents in case of emergency.
Authorisation to collect: Is someone you give permission to collect your child in an emergency and on other occasions. These persons may also be required to give written consent to the Approved Provider or Nominated Supervisor under the circumstances listed below. Personal identification is required from the people listed below to collect your child on your behalf.
Authorised to:
Authorised to:
Your child’s doctor:
Your child’s dentist:
SECTION D. PARENT CONSENT
SECTION E. APPLICATION for MEMBERSHIP of ASSOCIATION
Please note:
1. Membership is not transferable
2. Once approved, only the above signed is a member of Periwinkle Preschool Inc.
3. Initial membership is $5 for 2 years, & subsequent to the initial 2 years is renewable each year at $2 per year.
SECTION F. ACKNOWLEDGEMENTS