administration records - st john's college preschool€¦ · web viewenrolment hours and...

ENROLMENT AGREEMENT FORM

Enrolment Information, 20 Hours ECE Enrolment Hours and Attestation Information for Early Childhood Education Services

Any changes to the original enrolment agreement form must be signed and dated by the parent/guardian.

Child’s details:

Child’s official surname or family name:

Child’s official given name:

Child’s official other names / middle names: (please separate names with a comma):

Name your child is known by / preferred name:Surname / family name: Given name:

Copy of official identity verification document* collected by staff:

New Zealand birth certificate

New Zealand passport

Other ____________________________________

Foreign birth certificate

Foreign passport

Staff initials: _______________

Child’s date of birth: d d / m m / y y y y Male Female

Child’s ethnic origin/s: _________________________________________________________________________________

Iwi your child belongs to:_________________________________________________________________________________

Language/s spoken at home:_________________________________________________________________________________

Child’s primary residential address:

Post Code:

Privacy Statement:

We are collecting personal information on this enrolment form for the purposes of providing early childhood education for your child.We will use and disclose your child’s information only in accordance with the Privacy Act 1993. Under that Act you have the right to access and request correction of any personal information we hold about you or your child.Details about your child’s identity will be shared with the Ministry of Education so that it can allocate a national student number for your child. This unique identifier will be used for research, statistics, funding, and the measurement of educational outcomes. You can find more information about national student numbers at: www.minedu.govt.nz/parents

* Information about acceptable identity verification documents is available online at

www.lead.ece.govt.nz and www.minedu.govt.nz/parents.

Keep a copy of the identity verification document of each child who is enrolled at the service.

Parents / Guardians:

First Names: First Names:

Surname: Relationship: Surname: Relationship:

Address: Address:

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http://www.minedu.govt.nz/parents

http://www.lead.ece.govt.nz/

http://www.minedu.govt.nz/parents

Post Code: Post Code:

Phone (Home): Phone (Home):

Phone (Work): Phone (Work):

Phone (Mobile): Phone (Mobile):

Email: Email:



Address: Address:

Post Code: Post Code:




Email: Email:

Emergency Contacts (Other than parents/guardians):



Address: Address:




Email: Email:

Doctor:

Name: Medical Centre:

Phone: Address:

Requested Sessions:

Preferred Start Date: ___ /___ / ____

Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there are no compulsory fees when a child is receiving 20 Hours ECE funding. You are asked to make an optional payment to meet the costs outlined below.

Days Enrolled: Monday Tuesday Wednesday Thursday Friday

Times Enrolled: Total number

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of hours:

For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours

20 Hours ECE at this service

Total numberof hours:

20 Hours ECE at another service


Parent/Guardian Signature: ____________________________

Date:____ /____ /____

Enrolment Details: THIS SECTION TO BE COMPLETED ONCE OFFERED SESSIONS

Date of Enrolment:____ /____ / ___ Date of Entry: ____ /____ / ____ Date of Exit: ____ /____ / ____

Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there are no compulsory fees when a child is receiving 20 Hours ECE funding. You are asked to make an optional payment to meet the costs outlined below.

Days Enrolled: Monday Tuesday Wednesday Thursday Friday

Times Enrolled: Total numberof hours:

For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours

20 Hours ECE at this service


20 Hours ECE at another service


Parent/Guardian Signature: ____________________________

Date:____ /____ /__

20 Hours ECE Attestation:

1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service?

Tick One Yes No2. Is your child receiving 20 Hours ECE at any other services? Tick One Yes No

If yes to either or both of the above, please sign to confirm that:

Your child does not receive more than 20 hours of 20 Hours ECE per week across all services.

Your authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Agreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibility for 20 Hours ECE.

You consent to the early childhood education service providing relevant information to the Ministry of Education, and to other early childhood education services your child is enrolled at, about the information contained in this box.

Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____

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Optional Charges: (Please read 20 hours ECE Information letter included in Enrolment Handbook before signing this.)

1. The optional charge is for:

Providing higher than required Teacher: Child Ratio

Maintaining qualified trained teachers

The St John’s College Preschool 4 Year Old Programme

Building improvement projects including the playground, conservatory and heat /air-conditioning units

These are included in the daily fee schedule as below

2. I understand that if I agree to pay for the optional charge, St John’s College Preschool may enforce payment.

3. The agreement to pay the optional charge will last for the duration of my child’s enrolment

4. The rules about making changes to the agreement are:

Any changes to this agreement must be in writing within 3 weeks of the start date

Any changes must be with the consultation of the Director on a case-by-case basis

5. I understand that that optional charge is not compulsory and if I choose not to pay there will be no penalty.

6. Fees per day for the Wider Community are as follows: (College families please see enrolment pack).

Standard Fee: $8.40/hr<2 years old

Whole Day: 7.5 hours = $63.20am: 4 hours = $33.60pm: 3 hours = $25.20

Standard Fee: $7.90/hr>2 years old

Whole Day: 7.5 hours = $59.25am: 4 hours = $31.60pm: 3 hours = $23.70

Fee when using 20 Hours ECE (20 hours ECE subsidy only covers $4.60/hour for up to 6 hours/day, and 20 hours/week)

Whole Day: = $27.45am: = $ 10.40pm: = $ 7.80

7. I agree/do not agree (select one) to pay the optional charge for the activities/items specified in this enrolment agreement


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Statutory Holidays / Term Breaks

This enrolment agreement is inclusive of school term breaks except the Preschool is closed for approximately 3 weeks over the Christmas/New Year period, determined on a yearly basis. Notification of the closure is provided in October of every year.

St John’s College Preschool is closed on the following public holidays.

New Years Day

Day after New Year’s Day

Waitangi Day

Good Friday

Easter Monday

Easter Tuesday (College closed)

ANZAC Day

Queen’s Birthday

Labour Day

Christmas Day

Boxing Day

Auckland Anniversary Day.

Dual Enrolment Declaration

I hereby declare that my child is not enrolled at another early childhood institution at the same times that he/she is enrolled at St John’s College Preschool.


Custodial Statement

Are there any custodial arrangements concerning your child?

If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required)

Person/s who cannot pick up your child:

Name: Name:

Name: Name:

Health

Illness/allergies:

Is your child up-to-date with immunisations? Tick One Yes No

Immunisations record sighted and details recorded: Tick One Yes No

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Medicine

Category (i) Medicines

A category (i) medicine is a non-prescription preparation (such as arnica cream, savlon and dettol antiseptic liquid, anthisan insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the centre and kept in the first aid box.

Do you approve category (i) medicines to be used on your child? Tick One Yes No

Name/s of specific category (i) medicines that can be used on my child, provided by the centre:


Category (iii) Medicines

To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only

Individual health plan completed and signed: Tick One Yes No

Chronic illness/condition:

Name of medicine:

Method and dose of medicine:

When does the medicine need to be taken: (State time or specific symptoms)


Required Information for Licensing Purposes Excursions: As part of the preschool program we provide we will often utilise the surrounding College grounds and

neighbouring St John’s bush to learn through nature and the outdoors. This is confirmation that you consent to your child leaving the preschool premises to partake in this aspect of play, exploration and learning at St John’s College Preschool. Any other outings will be notified by written notice.

The teacher: child ratio for these outings will be:1:5 for Under 2, 1: 6 for Over 2, 7-20 children: 2 teachers. For more information please ask to sight our excursions policy.

Permission for the child to take part in regular excursions (under the conditions stated in the excursions policy)

Photo/video: permission for the child to be photographed for the purposes of assessment, planning and evaluation and to show at special events.

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Other Information (please circle)

Photo/video: permission to take photos of your child for use in our newsletter and on our website: Yes/No

Cyber safety Use Agreement for Parents/Caregivers read and Cyber safety Rules and Responsibilities signed: Yes/No

Policy Statement: St John’s College Preschool has a number of policies that set out the procedures that are in place for the care and education of the children who attend. These are in the Black folder a t the entrance way and also includes our Philosophy, and Centre Statement. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and understand how you can have input to policy review.

Parent Information Book: Please ensure you have read the information in the parent Enrolment Pack as it covers such things as fee details, subsidies that are available to you. It also includes ways in which we can help you and your child settle into the service, our 4 year old programme and information on the St John’s Theological College.

Child’s strengths, interests and preferences: Please fill in the enclosed form “All About Me”

Other areas you may wish to help: Committee, Working bees, fundraising. (please circle).

How did you hear about our preschool?

ADMINISTRATION FEE

A non-refundable administration fee of $20.00 is applicable for Community applications only, to be paid upon submitting this application to the preschool.

Please deposit payment into our account: 12-3086-0055400-00 quoting your child’s name as reference. Thank you for your payment.

Parent Declaration

I declare that all the above information is true and correct to the best of my knowledge


IF YOU HAVE SCANNED THIS DOCUMENT TO PRESCHOOL, PLEASE ENSURE ORIGINAL DOCUMENT IS KEPT SAVE AND DELIVERED TO PRESCHOOL ON ENROLMENT

Service Declaration

On behalf of St John’s College Preschool, I declare that this form has been checked and all relevant sections have been completed.Service provider/Director Signature: ___________________________ Date: _____/____/____

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ACKNOWLEDGEMENT OF CYBERSAFETY RULES & RESPONSIBILITIESTo the Parent/Legal Guardian/Caregiver:

1. Please read this page carefully as it includes information about your responsibilities under this agreement.

2. Complete and sign the section at the bottom of the page.3. Return this acknowledgement page to the centre (a copy will be returned to you).

St John’s College Preschool will: Do its best to enhance learning through the safe use of ICT. This includes working to restrict

access to inappropriate, illegal or harmful material on the Internet or centre ICT equipment/devices at the centre or at centre-related activities

Respond to any breaches in an appropriate manner Welcome enquiries from parents/legal guardians/caregivers about cybersafety issues.

I acknowledge that: I have access to St John’s College Preschool Cybersafety Use policy for Parents/Caregivers I am aware that I can ask to be given a copy of the St John’s College Preschool Cybersafety Policy I have read and am aware of the rules and responsibilities outlined in the Cybersafety Use

Agreement, a copy of which I have been advised to retain for reference.

I am aware that these obligations and responsibilities relate to the safety of the children attending the centre, and of the centre’s learning environment.

I also understand that breaches of this Use Agreement will be investigated and may require a response by St John’s College Preschool management comment.

Child’s /Children’s Names (print): …………………………………………………………………………………………

My Name (print): …………………………………………….………………………………………………………………..

Parent/Legal Guardian/Caregiver (please circle which term is applicable)

Signature: …………………………………………………………………………………… Date: ………………………..

Name of additional signatory* (if applicable): …………………………………………………………………………

Parent/Legal Guardian/Caregiver (please circle which term is applicable)

Signature: …………………………………………………………………………………… Date: ………………………..

*Additional parents/caregivers of the same child, may also sign the agreement. This will avoid the necessity to sign a separate agreement should the additional parent/caregiver visit the centre or use the centre ICT infrequently.

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What my day looks like:(During the day I have ……. many sleeps, usually for …….. hour/s. I have ……. bottles/milk. I eat lots and often etc).

ALL ABOUT ME:……………………………

……….

Special people in my life are:

My favorite song/s:

Allergies and/or things I don’t particularly enjoy:

When I am upset I find comfort in:

My favourite toys and activities at home are:

To be completed by Administrator

Infocare:

Details;

Official Names; Official Document sighted; NSN Allocated; Emergency Number s; Doctor

Bookings:

More details:

20 hrs ECE, WINZ

Immunisation

Ethnicity

Parent Contact list

Teacher allocated for Portfolio

Educa: Added for notices

Word:

Names printed (x2) for Board and Temporary Tag

Name Tag created

Portfolio created

Allergies: List updated if appropriate

Signed:................................................................. Date:……………………..

College Family: Yes / No

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administration records - st john's college preschool€¦ · web viewenrolment hours and...

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