Enrolment Form

Required Days
 Monday Tuesday Wednesday Thursday Friday

Parent 1

Parent 2

Authorised Nominee

Means a person who has been given permission by a parent or family member to collect the child from the childcare

Identification must be produced upon request from staff.

Health Information

Has your child been immunised?  Yes No

Has your child been vaccinated for Chickenpox?  Yes No

Has your child been immunised for Meningococcal?  Yes No

Has your child been immunised for Pneumococcal?  Yes No

Does your child have any specific healthcare needs including any medical conditions?  Yes No

Does your child have any known allergies?  Yes No