Child Care in Tasmania with NCN

CBC Child Care Enrolment Record

Before filling in this form, you should ensure that you have a copy of any supporting documentation that you may need, such as Immunisation Records, JET letters, Court Orders etc. These documents should be in PDF format. If you're unable to send them with this form, it's important to note that your enrolment won't be finalised, until these documents are received.

* required fields

Do you require an interpreter to help you with this form?

Which service do you require?

Have you used any of our Family Day Care, In Home Care, Long Day Care or Outside School Hours Care services before?

PARENT / GUARDIAN INFORMATION

Enrolling Parent / Guardian Information

The Enrolling Parent is the person who is registered for Child Care Subsidy (CCS)
Please note: In order to claim any Child Care Subsidy (CCS) and/or Child Care Rebate (CCR) you must provide the service with your CRN's.

If 'Working', please select from below:

Partner Information

You can enter your partner's information here.

If 'Working', please select from below:

IN CASE OF AN EMERGENCY

If you or your partner are not contactable, who else can be contacted?

You should also list any other person (other than yourself or partner) that may be collecting a child from care.

Contact Person One

Contact Person Two

Child's Doctor's Information

* I give consent for my Educator/Service to authorise medical treatment for my child from a registered Medical Practitioner:
* I give consent for my Educator to administer medication to my child, on my behalf as directed:
* Are there any Court, Custody, Care and Protection or Restraining Orders relevant to any children listed on this enrolment form?
If yes, a copy must be provided with this enrolment.
* Are all immunisations for children on this enrolment form up to date?
All immunisation evidence must be provided before care can take place.

It's important to note that the enrolment won't be formalised, until all documentation (such as Immunisation Records, Medical Management Plans) is received by NCN.

CHILD DETAILS

Child One

Child Two

Child Three

SPECIAL OR ADDITIONAL NEEDS

If your child has any medical conditions or developmental delays, please identify and provide details. For diagnosed medical conditions, an Action Plan will be required.

Allergies (Foods, insect bites, pollen etc)

Intellectual (Autism, Down Syndrome, Foetal Alcohol Syndrome etc)

Physical/Sensory (Cerebral Palsy, Cystic Fybrosis, Hearing/Visual impairment etc)

Developmental Delays (Language, Muscle Tone, Mobility etc)

Other Conditions (Asthma, ADHD, other Medical Conditions etc)

Other (including Cultural, Diet or Religion that the Educator needs to be aware of etc)

GENERAL INFORMATION

* Do you have any objections to pets? If yes, please detail below.
* Can NCN use images of your child for promotional / media or social media (e.g. Facebook) purposes?
* Can your Educator/Service use images of your child for program planning and resources?

CHILD CARE SUBSIDY PROCESSING INFORMATION

Will the child attending this service have already attended another approved child care service in the current financial year?
Will this child be attending another approved child care service as well as this service?
Does this child have a sibling, listed on the family assessment notice that will be attending another service which will deem you eligible for a two child entitlement?

If you answered YES to any of the above questions, it may affect your child's CCS entitlement. It is important that you keep your information up to date with the service and the Department of Health & Human Services to avoid any overpayment.

How did you hear about us?

SUPPORTING DOCUMENTATION

You should supply us with any supporting documentation, such as Immunisation Records, JET letters, Court Orders etc.

Send us your supporting documentation

STATEMENT

I agree to abide by the current conditions and policies of Northern Children’s Network Inc. (available to view at each service/offices or educator).

I agree to my child/ren being cared for and/or transported by service staff in an emergency.

I agree to my child/ren receiving medical attention and being transported by ambulance in an emergency as recommended by the doctor, hospital, ambulance staff or paramedics.

I understand that non work related care hours may be reduced or ‘placed on hold’ to accommodate work or study related care. This practice is in accordance with the Commonwealth Priority of Access Guidelines.

I agree to pay the organisation’s Administration Levy every week to the Educator and understand this amount will be deducted from any Child Care Subsidy payment due to the Educator on my behalf.

I agree to complete a Service/Parent Care Agreement at the commencement of care.

I agree to a copy of the information contained on this enrolment form being forwarded to the Educator/service upon the commencement of care.

I agree to advise the service and my Educator/s within 14 days of any change in the information provided.

I agree that the service may from time to time send newsletters and other relevant information electronically to my email account.

I agree to pay the account received by me by the due date. If the account is not paid by the due date, then that account may be lodged with a mercantile agent for recovery. If lodged with a mercantile agent for recovery, I, the parent, will bear all collection costs to cover the agent’s commission. In addition, I agree to bear all legal costs and disbursements incurred in the recovery of the debt.

The information that I have provided on this form is true and accurate at the time of completion.