OSHC Enrolment Form

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Coldstream OSHC/Vacation Care Enrolment Form
Welcome to Coldstream OSHC! This form must be completed by a parent or guardian who has lawful authority in relation to the child. If you are
experiencing any difficulties with filling out this form or require a translator, please do not hesitate to contact our OSHC team on 9739 1680.
Child details
Child family name: __________________________________ Child First Name: _____________________
Date of Birth: __________________________ Child CRN: _____________________________________
Country of Birth ___________________________ Language Spoken at Home: _____________________
Aboriginal / Torres Strait Islander? Yes No Culture ___________________ Gender: Male  Female 
Has your child attended an OSHC or child care center in the past? Yes  No 
Child Care Benefit
Number of children in care (OSHC or Childcare): ________ Child Care Subsidy weekly? Yes/No
If you are claiming the Child Care Subsidy to reduce your weekly fees, you will need to contact the Family Assistance Office immediately.
Parent/Carer/Guardian (responsible person for fees, FAO registration, and as well as the co-parent listed, authorised to authorise an
educator to take the child outside the education and care service premises)
Family name: ______________________________ Given name: _____________________________
Date of Birth ______________________ CRN ____________________________________ Gender Male Female 
Country of birth: __________________________ Language ___________________
Cultural back ground and religious/cultural beliefs:_____________________________________________________
Address: ___________________________________________________________________________ ______________________________Postcode________________
Home phone: _________________________________ Mobile: _________________________________
Work Phone: _________________________________ Home email: ____________________________
Child lives with this parent  Yes  No Marital Status____________________________
Co –Parent/Carer/Guardian Details
Family name: ______________________________ Given name: ________________________________
Date of Birth ______________________ CRN ___________________________________Gender Male Female 
Country of birth: __________________________ Language ____________________________
Cultural back ground and religious/cultural beliefs:_____________________________________________________
Address: ___________________________________________________________________________
_________________________________________________________________Postcode___________
Home phone: _________________________ Mobile: __________________________________________
Work Phone: _____________________ Home email: __________________________________________
Child lives with this parent  Yes  No Marital Status____________________________
Doctor/Health fund details
Doctor’s name: ______________________________Doctor's Phone: ________________________
Doctor's address: ___________________________Medicare no:____________________________
Maternal Child Health Nurse: ___________________________Private Health fund: ___________________
MCH contact: ________________________________Health Fund Number: __________________
MCH phone: _________________________________Ambulance Subs no: ____________________
Court Order Details
Are there any court orders relating to the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child?
YES  NO  If yes, complete next section:
If yes, please bring the original court order/s for staff to see and a copy to attach to this enrolment form.
Please notify us immediately If these orders:

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a. Change the powers of a parent/guardian to:
- Authorise the taking of the child outside the service by a staff member of the service
- Consent to the medical treatment of the child
- Request or permit the administration of medication to the child
- Collect the child
AND/OR
b. Give these powers to someone else.
Emergency Contacts
There may be times when the child has an accident, injury, trauma or illness and the parents or guardians cannot be contacted. To deal with these
situations our procedure is for our staff to notify one of the following people who are authorised nominees to collect, administer, give consent to medical
treatment from a medical practitioner, hospital or ambulance service or give permission for an educator to take the child outside the service in your
absence. Note that any person who does not usually attend our service to collect your child will be asked for Photo Identification. Our staff will
not release a child to the following nominated people without written confirmation by the parent or guardian, and confirmed photo identification. Please
nominate minimum of two people other than the parent/guardians of the children. To avoid possible problem please inform the nominated
people of their responsibilities and our procedures.
Contact 1 Authorised Nominee for Emergency details
Name: __________________________________________________________________________________________________
Address: ________________________________________________________________________________________________
Home phone: __________________________________ Work phone: _________________________________________
Mobile: _______________________________________ Relationship to child: ___________________________________
Authorised to – (tick all that apply)
□ collect in the event of an accident, injury, trauma or illness
□ Give consent for administration of medication
□ Give consent for medical treatment from a medical practitioner, hospital or ambulance service including transportation
□ Delgate the authority to an educator to take the child outside the education and care service premises.
Contact 2 Authorised Nominee for Emergency details
Name: ___________________________________________________________________________________________________
Address: ________________________________________________________________________________________________
Home phone: ________________________________ Work phone: ___________________________________________
Mobile: _______________________________________ Relationship to Child: ___________________________________
Authorised to – (tick all that apply)
□ collect in the event of an accident, injury, trauma or illness
□ Give consent for administration of medication
□ Give consent for medical treatment from a medical practitioner, hospital or ambulance service including transportation
□ Delgate the authority to an educator to take the child outside the education and care service premises.
Your consent is required for other people to collect the child from the service on your behalf. Please list the details of those people
who can collect your child. In the event that the child is not collected from the service and the parents or guardians cannot be
contacted, this list will also be used to arrange someone to collect the child
Contact 1 Authorised Nominee for Collection details
Name: ________________________________________________________________________________________
Address:___________________________________________________________________________________________________________________________________________________________
Home phone: __________________________________ Work phone: ______________________________
Mobile: _____________________________________ Relationship to child: ______________________________

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Contact 2 Authorised Nominee for Collection details
Name: ________________________________________________________________________________________
Address:____________________________________________________________________________________
Home phone: ________________________________ Work phone: ________________________________
Mobile: ______________________________________ Relationship to Child: _____________________________
Child health details
Dietary Restrictions: ______________________________________________________________________________
Allergies: ______________________________________________________________________________________
What is your child’s reaction if they are exposed to their allergen? _______________________________________
Does your child suffer any of the following?
 Asthma
 Anaphylaxis
 Epilepsy
 Diabetes
 Other Medical Condition – please give details: _______________________________________________________
(Please attach a management plan if required)
Ongoing Medications: ____________________________________________________________________________
Has your child ever experienced convulsions resulting from a high temperature? Yes / No
Accident History: ________________________________________________________________________________
Illness History: ________________________________________________________________________________
Immunisation records:
Has the child been immunised? Yes  No  (please tick) If yes, provide the details by:
 attaching a copy of the Immunisation Record print out from local government
 From Medicare
 Medicare express plus App on your Mobile
 Telephone: 1800 653 809
 Email: acri@medicareaustralia.gov.au
 Online: www.humanservices.gov.au/customer/services/medicare/medicare-online-accounts
 Or in person @ any Medicare Centre
Parental Declaration & Consent
I, (print full name) a person with lawful authority of the child referred to in this
enrolment form,
 Agree to be liable for payment of fees (as per our fees schedule) incurred each week. I understand my fees will be charged in advance and
due and payable each week, these charges will include charges for the current week plus one extra week in advance.
 Understand my fees will be deducted at service level by the management team through my credit card provided.
Office too complete
Has the original immunisation record been copied: Yes 
Signature_____________________________date:____________________________________

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 Understand full fees are payable until Child Care Subsidy confirmation is received by the service.
 Understand fees are charged on all booked days that my child does not attend due to illness, holidays, general absences and public holidays.
 Understand late collection of children after 6:00pm will result in late fee charges being added to my account as per the policy and will be
due and payable on the following Monday.
 Understand that I am liable to pay penalty interest on any late payments which result in an overdue account (Please note: interest will be
charged at the current rate pursuant to the Penalty Interest Rates Act).
 Agree to provide 2 weeks’ notice in writing to the director, if I/we intend to change booked days or cease attendance at Coldstream OSHC
for the above child and understand I am required to pay for the two weeks’ notice provided.
 Understand that Coldstream OSHC is mandated to follow the priority of Access guidelines as a CCS approved services, therefore if I am not
working or studying and a higher priority child needs a place, I understand that Coldstream OSHC may require a change in my child’s
booked days, if no change is available I further understand that I may be given 14 days’ notice of my need to withdraw my child to make
way for a child of a higher priority. More information on these guidelines is available at. www.education.gov.au
 Agree to read and accept all policies at Coldstream OSHC.
Signature: Date:
Declaration and Consent To Emergency Medical Treatment
I, (print full name), a person with lawful authority of the child referred to in this
enrolment form,
 declare that the information in this enrolment form is true and correct and undertake to immediately inform the Coldstream OSHC in the
event of any change to this information;
 agree to collect or make arrangements for the collection of the child referred to in this enrolment form if s/he becomes unwell at the
service;
 consent to the staff of the service seeking medical treatment from a registered medical practitioner, hospital or ambulance service
including transportation if required by ambulance, or where appropriate, administering, such emergency medical treatment as is
reasonably necessary and that I will reimburse any necessary expenses incurred by the service.
Signature Date
Consent to Administer Panadol
 Coldstream OSHC is not equipped to look after sick children. If your child is unwell, please keep them home until they are well enough to
attend. Please refer to our policy in regards to illness and exclusions from Coldstream OSHC.
Has your child been given Panadol in the past? Yes  No  (please tick)
I, (print full name), a person with lawful authority of the child referred to in this
enrolment form,
 agree to the child referred to on this enrolment form being administered 1 dose only of liquid Paracetamol by the staff at Coldstream OSHC
following permission by a lawfully authorised person on this form given to 2 staff members over the phone (for extremely high
temperatures only whilst awaiting immediate collection of the child)
Signature: Date:
Hair And Scalp Examination Consent
Please remember that head lice do not discriminate and any child or adult can be infected. Our staff will make every effort to ensure your child
does not suffer any unnecessary embarrassment or trauma as a result of having head lice. A child with head lice will not be separated from
other children whilst you are contacted we will ask you to come in and collect your child to complete appropriate treatment. If you are not
contactable we will then contact your nominated emergency contact on your enrolment form.
I, (print full name)
A person with lawful authority of the child referred to in this enrolment form,
 agree to the staff at Coldstream OSHC conducting a short non-evasive hair and scalp examination of the child referred to on this enrolment
form for the specific purpose of detecting the presence of head lice.
 Agree that if the child referred to on this enrolment form has a confirmed case of head lice I will collect the child as soon as possible and
will commence the recommended treatment immediately.
 Agree that when the child referred to on this enrolment form first returns to Coldstream OSHC after the initial treatment my child may be
re-examined again to verify successful treatment.

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Coldstream OSHC
acknowledges the support of
the Victorian Government.
 Understand that my child will not be allowed to return to Coldstream OSHC until all lice have been treated and removed.
Signature: Date:
Sunscreen
I _____________________________ agree to the staff at Coldstream OSHC applying water resistant 30+ plus sunscreen to my child as per the sun
protection policy when the UV rating is above 3.
Where my child requires special sunscreen for sensitive skin, I will provide the service with a sensitive sunscreen to be applied at the service.
Signature: _____________________________________________ Date: ___________________________
Photography Consent
At Coldstream OSHC we take photos of staff and children while they are in routines and at play. There are a number of reasons why we take
photographs such as;
- Illustrating to children how we do certain routines (e.g. washing hands)
- Providing visual documentation for parents to see what their children have done throughout the day
- Photo observations and evaluations for programming
- To use as part of a gift (e.g. Mother’s Day, Father’s Day, Christmas etc.)
Photos will not be taken home by staff, volunteers, or students.
I _________________________________________ (print full name) decline/give permission for staff at Coldstream OSHC to take photos of my child/ren to be
used for the purposes stated above.
Signature: ______________________________________ Date: __________________
I _________________________________________ (print full name) decline/give Coldstream OSHC permission to collect information regarding my child’s
health and enrolment records from Coldstream Primary School. (This can help reduce collecting another set of medical plans etc.)
Signature: ______________________________________ Date: __________________
Parental Responsibility
Parents
All parents have powers and responsibilities in relation to their children which can only be changed by a court order. The Children’s Education
and Care Services National Regulations 2011 refer to these powers and responsibilities as ‘Parental Responsibility’. It is not affected by the
relationship between the parents, such as whether or not they have lived together or married.
A court order, such as under the Family Law Act, may take away the authority of a parent to do something, or may give it to another person.
Guardians
A guardian of a child also has lawful authority. A legal guardian is given lawful authority by a court order. The definition of ‘guardian’ under the
Education and Care Services National Law Act 2010 also covers situations where a child does not live with his or her parents and there are no
court orders. In these cases, the guardian is the person the child lives with who has day-to-day care and control of the child.
Coldstream OSHC acknowledges Aboriginal people as the
traditional custodians of the land on which we operate.
We commit to working respectfully to honour their
ongoing cultural and spiritual connections to this
country.

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OSHC Booking form 2019
OSHC care is provided during the school term, Monday through Friday. Excludes public holidays and student free days.
Before School Care
7am-8.45am
$15pp permanent
$17pp casual
After School Care
3.15pm-6.00pm
$20pp permanent
$22pp casual
Name of child:________________________
Parent/Carer/Guardian name:______________________
Signature:_______________________________
Date:_____________
By signing this form you agree to the terms and conditions set out in the Coldstream OSHC enrolment form,
Coldstream OSHC parent handbook and Coldstream OSHC service policies.
Monday Tuesday Wednesday Thursday Friday
Monday Tuesday Wednesday Thursday Friday

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Coldstream OSHC
Vacation Care & Student Free Day Care
Coldstream Vacation Care is open 7am-6.00pm Monday-Friday during school holidays, excluding public holidays.
Student Free Day Care will be open 7.00am-6.00pm.
Each child will need to complete an enrolment form before attending Vacation Care/ Student Free Day Care. (If you
are already enrolled into OSHC, you will not need to re do an enrolment form for Vacation Care/Student Free Day
Care.)
Prior to each school holiday period we will send out a Vacation Care form with activities that will be on each day and
terms and conditions. It is important that you get that form back and paid for 2 weeks before Vacation Care starts to
ensure your place is secure. ***Vacation Care Days and Student Free Day Care will provide breakfast, morning, tea,
lunch, afternoon tea and late snack. Menus will be attached to each booking form.*** (unless instructed otherwise
e.g. vacation excursion days may ask for you to provide a packed lunch & snack)
Coldstream OSHC Vacation and Student Free Day Care 2018 fees
Normal Vacation
Care day
$100 per child per day Childcare Fee support from the government
From 2 July 2018, a New Child Care Package was put in place.
The Package will help parents with children aged 0 – 13 work, train,
study and volunteer. The Package includes a new Child Care Subsidy,
which replaces the current Child Care Benefit and Child Care Rebate.
It will be paid directly to services.
Transitioning to the new Child Care Subsidy is not an automatic roll
over from the old system. Ensure you apply to Centrelink.
We can give you an estimate on how much care will cost you based
on your Centrelink information. For more info go to:
https://www.education.gov.au/ChildCarePackage
Incursion Vacation
Care day
$110 per child per day
Excursion Vacation
Care day
$120 per child per day
Student Free Day
Care
$100 per child per day
(full day)