Enrol Now | Learning Ladder ELC

Centre Location *

Start Date *

Your Child's Details

Child Name *

First

Last

Child's Preferred Name (if any)

Child Gender *

Child Date Of Birth *

Centrelink Reference Number (CRN) *

Child's Home Address *

Child Lives With... *

REQUIRED DAYS OF ATTENDANCE

Monday Start Time

Monday Finish Time

Tuesday Start Time

Tuesday Finish Time

Wednesday Start Time

Wednesday Finish Time

Thursday Start Time

Thursday Finish Time

Friday Start Time

Friday Finish Time

Primary Parent/Carer

Education And Care Services National Regulations - Regulation 160 (3B)

Parent Name *

First

Last

Parent Email *

Parent Home Address

parent Child live with you *

PARENT CENTRELINK REFERENCE (CRN)

Parent Relationship To The Child *

Parent Home Phone Number *

Parent Mobile Phone Number

Parent Work Phone Number

Parent Date Of Birth *

Parent Country Of Birth

Parent Cultural Background Details

Parent Occupation

Parent Place Of Employment

Parent Hours Of Work

Secondary Parent/Carer

Education And Care Services National Regulations - Regulation 160 (F, G, H)

Parent Secondary Name *

First

Last

Parent Secondary Email *

Parent Secondary Child live with you *

Secondary Parent/Carer Centrelink Reference Number (CRN) *

Parent Secondary Relationship To The Child *

Parent Secondary Home Phone Number *

Parent Secondry Mobile Phone

Parent Secondary Work Phone

Parent Secondary Date Of Birth *

Cultural Consideration

Education And Care Services National Regulations - Regulation 160 (F, G, H)

Language/s Spoken At Home

Ethnicity

Is The Child Of Aboriginal Or Torres Strait Islander Descent? *

Please Outline Any Cultural Practices You Would Like Followed

Please Outline The Child's Religious Background And If Relevant Any Religious Practices You Would Like Followed

Religious Celebrations Observed

Medical Information

Education And Care Services National Regulations - Regulation 160 (3a, I, J))

Medicare Number *

Medicare Expiry Date *

Number Of Child On Card *

Child's Registered Medical Practitioner Or Service Details

Medical Service/Client Name *

Medical Practitioners Name *

Medical Practitioners Contact Number *

Medical Practitioners Address *

Child's Registered Dental Practitioner Or Service Details

Dental Service/Client Name *

Dental Practitioners Name *

Dental Medical Contact Number *

Dental Address *

Private Health Insurance? *

Private Health Fund Name

medical Private Health Care Membership Number

Ambulance Cover

Does The Child Have Any Specific Health Care Needs Or Conditions, Including Allergies Or Anaphylaxis

If yes, please provide a medical management plan, which the child's medical practitioner has prepared. The Plan should include:

A photo of the child
If relevant, state what triggers the medical condition, allergy or anaphylaxis
First aid needed
Contact details of the doctor who signed the plan
When the Plan should be reviewed

Does The Child Have Any Dietary Restrictions? *

Medication will only be administered if it is in the original container with the original label and instructions that can be clearly read and before the expiry or use by date. Additionally, if the medication has been prescribed by a medical practitioner:

The label must contain the child's name and
Parents must provide any verbal or written instructions provided by the medical practitioner.

Education and Care Services National Regulations Regulation 95
Any medication, including non-prescription medication like nappy creams and paracetamol, must be authorised by parents or an authorised nominee on our “Administration of Authorised Medication” form.Education and Care Services National Regulations Regulation 93

Do You Authorise The Nominated Supervisor Or Another Educator At The Service To Seek Medical Treatment From A Registered Medical Practitioner, Hospital Or Ambulance Service? There May Be Emergency Situations That Arise Where We May Determine The Health And Safety Of The Child Is At Risk, And May Seek Medical Treatment Or Advice Prior To Contacting Parents Or Guardians. *

Do You Authorise The Nominated Supervisor Or Other Educator At The Service To Seek Dental Treatment From A Registered Dental Practitioner Or Service In The Event Of An Emergency? *

Immunisation Details

I Have Chosen Not To Have My Child Immunised. *

Please note: Approved documentation must be provided before your child can attend. See Immunisation Policy This can be uploaded at the end of this form.

Are Your Child's Immunisations Up To Date? *

Please note: Approved documentation must be provided before your child can attend. See Immunisation Policy This can be uploaded at the end of this form.

Do You Authorise The Nominated Supervisor Or Other Educator To Transport The Child In An Ambulance In The Event Of An Emergency? *

Please Be Advised That If A Child Is Diagnosed With Asthma Or Anaphylaxis And An Emergency Occurs, The Nominated Supervisor Or Other Educators May Administer Emergency First Aid Without Prior Contact. Educators Will Notify The Child’s Parents And/Or Emergency Services As Soon As Possible. This Is In Accordance With The Education And Care Services National Regulations - Regulation 94. *

Developmental Information

Has your child undergone or is currently undertaking assessments to support any particular developmental areas, such as speech therapy, occupational therapy, or Autism Spectrum Disorder? If yes, please attach any supporting documents. Additionally, please provide us with any other information we should know about your child.

Family Information

Does The Child Have Any Siblings? If So, Please Provide Their Names And Ages. *

Does The Child Have Any Other Close Relatives Attending The Service (E.g., Cousins)? If Yes, Please Provide Their Names And Ages. *

Child's Routine

Child's Routine *

Child's Routine

Education And Care Services National Regulations - Regulation 160 (3C, D)

Are There Any Court Orders, Parenting Orders Or Parenting Plans Relating To The Powers, Duties And Responsibilities Or Authorities Of Any Person In Relation To The Child Or Access To The Child? *

If yes, please provide all relevant documentation and paperwork. Please note that without this documentation we cannot legally enforce the Order/s.

Are There Any Other Court Orders Relating To The Child's Residence Or The Child's Contact With A Parent Or Other Person? *

If yes, please provide all relevant documentation and paperwork. Please note that without this documentation we cannot legally enforce the Order/s.

First Emergency Contact

Education And Care Services National Regulations - Regulation 160 (3B, II, III, IV, V) 161 (1A, I, II, 1B)

There May Be Times Or Situations Where Your Child Has Had An Accident, Injury, Trauma Or Illness And Parent/s Cannot Be Reached Or Are Unable To Collect Their Child. To Deal With These Circumstances And In Case Of An Emergency The Service Will Inform The Following Person To Collect And Care For The Child. This Person Must Live A Maximum Of 30 Minutes From The Service And Must Provide Identification When Collecting The Child.

Please Obtain The Person's Consent Before Listing Them As An Emergency Contact

First Emergency Name *

First Emergency Relationship To Child *

First Emergency Contact Address *

first Emergency Email *

First Emergency Home Contact *

First Emergency Mobile Contact

First Emergency work Contact

Can This Person Be Contacted To Give Consent For Medical Treatment Or To Authorise For A Nominated Supervisor Or Educator To Administer Medication To The Child In The Event That You Cannot Be Contacted? *

Can This Person Be Contacted To Give Consent For Educators To Take The Child Outside The Service's Premises In The Event That You Cannot Be Contacted? *

Can This Person Be Contacted To Give Consent To The Transportation Of The Child By An Ambulance Service? *

Can This Person Give Authorisation For The Service To Take The Child On Regular Outings? *

Second Emergency Contact

Education And Care Services National Regulations - Regulation 160(3B, II, III, IV, V) 161 (1A, I, II, 1B)

Please obtain the person's consent before listing them as an emergency contact

Second Emergency Name *

Second Emergency Relationship To Child *

Second Emergency Contact Address *

Second Emergency Email *

Second Emergency Home Contact *

Second Emergency Mobile Contact

Second Emergency work Contact

Can This Person Be Contacted To Give Consent For Educators To Take The Child Outside The Service's Premises In The Event That You Cannot Be Contacted? *

Can This Person Be Contacted To Give Consent To The Transportation Of The Child By An Ambulance Service? *

Can This Person Give Authorisation For The Service To Take The Child On Regular Outings? *

Child Care Subsidy (CCS)

Child Care Subsidy Will Be Paid Directly To The Service To Reduce The Fees Families Pay. To Claim Child Care Subsidy (Ccs) Families Must Meet Eligibility Requirements Which Include:

You And/or Your Partner Must Care For Your Child At Least 2 Nights Per Fortnight Or Have 14% Care? *

Are You Liable For Fees For Care Provided At An Approved Child Care Service? *

Do You Meet Residency Requirements? *

Does Your Child Meet Immunisation Requirements? *

Have You Completed The Child Care Subsidy Assessment On The MYGOV Website? *

Have You Received Confirmation About Your Child Care Subsidy? *

ABN 32 095 551 581
APCA ID 518466 | AFSL 338256

LL Cranbourne Direct Debit Request - Authorisation Form

Select from the Following *

New Account
Change Debit Limit
Change Account Details

Payment Details

Payment Limit Amount *

This is the maximum amount to deduct at each centre where a balance occurs

Surcharg

Visa/MasterCard:: 2.35%
AMEX:: 4.40%
Bank Account:: N/A
Admin Fee:: $2.20

Payment frequency: *

Weekly (default)
Fortnightly
4-Weekly
Monthly

Day of the week *

Day of the month *

First Payment Date *

Direct Debit from Bank Account, Building Society Or Credit Union

Details of the Account to be debited (All Details must be supplied):

Account Name

BSB Number:

Account Number

I/We authorise Debitsuccess Pty Ltd, ABN 095 551 581, APCA User ID Number 518466 to debit my/our account at the Financial Institution identified here through the Bulk Electronic Clearing System (BECS)

Credit Card

Please charge my payments to my:

Visa
MasterCard
AMEX

Card number

Expiry Month:

Expiry Year

Name on Card

Signature

This Authorisation is to remain in force in accordance with the Terms and Conditions on this Direct Debit Request, the provided DDR Service Agreement, and I/we have read and understood the same

Authorising Signature (s) *

Clear Signature

Date *

Terms and Conditions *

You are agree to our Terms and conditions

Read Terms and Conditions

Your Child's Details

REQUIRED DAYS OF ATTENDANCE

Primary Parent/Carer

Education And Care Services National Regulations - Regulation 160 (3B)

Secondary Parent/Carer

Education And Care Services National Regulations - Regulation 160 (F, G, H)

Cultural Consideration

Education And Care Services National Regulations - Regulation 160 (F, G, H)

Medical Information

Education And Care Services National Regulations - Regulation 160 (3a, I, J))

Child's Registered Medical Practitioner Or Service Details

Child's Registered Dental Practitioner Or Service Details

Medication will only be administered if it is in the original container with the original label and instructions that can be clearly read and before the expiry or use by date. Additionally, if the medication has been prescribed by a medical practitioner:

Immunisation Details

Developmental Information

Family Information

Child's Routine

Child's Routine

Education And Care Services National Regulations - Regulation 160 (3C, D)

First Emergency Contact

Education And Care Services National Regulations - Regulation 160 (3B, II, III, IV, V) 161 (1A, I, II, 1B)

Second Emergency Contact

Education And Care Services National Regulations - Regulation 160(3B, II, III, IV, V) 161 (1A, I, II, 1B)

Child Care Subsidy (CCS)

Child Care Subsidy Will Be Paid Directly To The Service To Reduce The Fees Families Pay. To Claim Child Care Subsidy (Ccs) Families Must Meet Eligibility Requirements Which Include:

LL Cranbourne Direct Debit Request - Authorisation Form

Payment Details

Surcharg

Direct Debit from Bank Account, Building Society Or Credit Union

Details of the Account to be debited (All Details must be supplied):

I/We authorise Debitsuccess Pty Ltd, ABN 095 551 581, APCA User ID Number 518466 to debit my/our account at the Financial Institution identified here through the Bulk Electronic Clearing System (BECS)

Credit Card

Signature

This Authorisation is to remain in force in accordance with the Terms and Conditions on this Direct Debit Request, the provided DDR Service Agreement, and I/we have read and understood the same

Cranbourne

Watsonia

Wyndham Vale

Narre Warren

Epping

Preston

Your Child's Details

REQUIRED DAYS OF ATTENDANCE

Primary Parent/Carer

Education And Care Services National Regulations - Regulation 160 (3B)

Secondary Parent/Carer

Education And Care Services National Regulations - Regulation 160 (F, G, H)

Cultural Consideration

Education And Care Services National Regulations - Regulation 160 (F, G, H)

Medical Information

Education And Care Services National Regulations - Regulation 160 (3a, I, J))

Child's Registered Medical Practitioner Or Service Details

Child's Registered Dental Practitioner Or Service Details

Medication will only be administered if it is in the original container with the original label and instructions that can be clearly read and before the expiry or use by date. Additionally, if the medication has been prescribed by a medical practitioner:

Immunisation Details

Developmental Information

Family Information

Child's Routine

Child's Routine

Education And Care Services National Regulations - Regulation 160 (3C, D)

First Emergency Contact

Education And Care Services National Regulations - Regulation 160 (3B, II, III, IV, V) 161 (1A, I, II, 1B)

Second Emergency Contact

Education And Care Services National Regulations - Regulation 160(3B, II, III, IV, V) 161 (1A, I, II, 1B)

Child Care Subsidy (CCS)

Child Care Subsidy Will Be Paid Directly To The Service To Reduce The Fees Families Pay. To Claim Child Care Subsidy (Ccs) Families Must Meet Eligibility Requirements Which Include:

LL Cranbourne Direct Debit Request - Authorisation Form

Payment Details

Surcharg

Direct Debit from Bank Account, Building Society Or Credit Union

Details of the Account to be debited (All Details must be supplied):

I/We authorise Debitsuccess Pty Ltd, ABN 095 551 581, APCA User ID Number 518466 to debit my/our account at the Financial Institution identified here through the Bulk Electronic Clearing System (BECS)

Credit Card

Signature

This Authorisation is to remain in force in accordance with the Terms and Conditions on this Direct Debit Request, the provided DDR Service Agreement, and I/we have read and understood the same

Thank You for Contacting Us!