Application Form

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Child’s details - Step 1 of 11

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):

Copy of official identity verification document* sighted by staff

New Zealand birth certificate
New Zealand passport
Foreign birth certificate
Foreign passport
Other

Child’s date of birth

Gender

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 purpose of providing early childhood education for your child. We will use and disclose your child’s information only in accordance with the Privacy Act 2020. Under the Act you have the right to access and request correction of any personal information we hold about you and your child.

Personal information about your child collected on this enrolment form is shared with the Ministry of Education who store it securely and treat it in accordance with the Privacy Act 2020. Information is disclosed to the Ministry: for funding allocation purposes, for monitoring purposes, to allow the assignment of a National Student Number* to your child, and to allow the Minister or Secretary of Education to exercise any of their other powers or responsibilities under the Education and Training Act 2020, and as permitted by Privacy Principles 10 and 11. Completed forms may also be viewed by Ministry officials on request for the purposes of monitoring and licensing.

* A National Student Number is a unique identifier for your child within the education system. You can find more information about National Student Numbers and what they are used for at National Student Number (NSN) » NZQA

The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, which if received, should be securely destroyed once verified.

Given names of Parents / Guardians

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone (Home)

Phone (Work)

Phone (Mobile)

Relationship to child *

Additional Emergency Contacts (also able to pick up child):

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone (Home)

Phone (Work)

Phone (Mobile)

Relationship to child *

Custodial Statement

Are there any custodial arrangements concerning your child? *

given allergies yes

Person/s who cannot pick up your child

Name *

First

Last

Child’s doctor

Name *

Phone

Name of medical Centre

Happy Turtle Childcare provides food to children. The foods that pose a high choking risk will not serve by service to children unless prepared in accordance with best practice as set out in Ministry of Health: Reducing food-related choking for babies and young children at early learning services.

Health

Does your child have any specific illness or allergies or dietary requirement?

Specific illness or allergies or dietary requirement (If yes please specify below)

Is your child up to date with immunisations?

(Please provide verification of all immunisations) if Yes

Medicine

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

Note: The service must provide specific information about the category (i) preparations that will be used.

Do you approve category (i) medicines to be used on your child?

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

Medicine Name

Parent/Guardian Signature: _______________________

Date

Category (ii) Medicines

Category (ii) Medicines
Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service.

I acknowledge that written authority from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given.

Parent/Guardian Signature: _______________________

Date

Category (iii) Medicines

Category (iii) Medicines
To be filled in if your child requires medication such as inhalers (puffers), Sudocrem, EpiPen as part of an individual health plan, for example for an on-going condition such as asthma or eczema, nappy rash, diabetes etc and is for the use of that child only.

For staff: Individual health plan sighted, and a copy taken: Tick One:

Name of medicine

Method and dose of medicine

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

Parent/Guardian Signature: _______________________

Date

Enrolment Details

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 must be no compulsory fees when a child is receiving 20 Hours ECE funding.

Days Enrolled:	Monday	Tuesday	Wednesday	Thursday	Friday
Times Enrolled:						Total hours:
For 20 Hours ECE fill out boxes below with the hours attested e.g., 6 hours
20 Hours ECE at this service						Total hours:
20 Hours ECE at another service						Total hours:

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?

2. Is your child receiving 20 Hours ECE at any other services?

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

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

§ You 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

Dual Enrolment Declaration

I hereby declare that my child is/is not enrolled at another early childhood institution at the same times that he/she is enrolled at [insert name of service].

Parent/Guardian Signature: _______________________

Date

Optional Charges

(Note: Your service must not require you to pay fees for the 20 hours ECE your child is receiving.)

1. The optional charge is for: (give details of specific activities or items, and their costs)

· $_________.____

2. I understand that if I agree to pay for the optional charge, Happy Turtle Childcare may enforce payment.

3. The agreement to pay the optional charge will last for the time your child is enrolled at Happy Turtle Childcare.

4. The rules about making changes to the agreement are: Give us two weeks written notice.

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

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

Parent/Guardian Signature: _______________________

Date

Statutory Holidays

Happy Turtle Childcare is closed on statutory holidays if it falls on a weekday.

Activity Consent:

1. I hereby give permission for my child to use all play equipment indoor and outdoor, considered appropriate to his/her age level and to participate in all activities of Happy Turtle Childcare Centre Papakura Ltd.t/a Happy Turtle Childcare

2. I have read and understood the excursion Policy and I hereby grant permission for my child to leave the Centre premises under supervision as per the policy for neighborhood walks, picnics, or other excursions.

3. I have viewed the sleeping facilities and read the sleeping policy.

4. I have read and understood the ‘Positive guidance policy and developing social competency’ which gives discretion for Happy Turtle Childcare Centre Papakura Ltd.t/a Happy Turtle Childcare, to take action within their policies, If the inappropriate behaviour persists after the behaviour action plan, Happy Turtle Childcare will request the parent to disenroll the child.

5. Photos/ Video

a. I have permission for the child to be photographed and videoed for the purposes of assessment, planning and evaluation (explain clearly how the photos/videos can/cannot be used) YES /NO (Circle one)

b. I give permission for photographs or videos of the child to be used on the Centre’s website, Facebook, or newsletters, with your permission. YES/NO (Circle one)

c. I give permission for my child to be photographed, observed, evaluated and photos displayed at the Centre. I also agree to records about my child (as per Ministry requirements) being kept. YES/NO (Circle one)

6. I give permission for my child to be involved in food or cooking activities whilst he/she is attending the Centre. YES/NO (Circle one)

7. B4 School Hearing and Vision Checks: Vision and Hearing technicians will visit our Centre to check the hearing and vision of four-year-old children who have not been seen for the above checks or require re- checks from a previous visit. Your child’s name, date of birth and National Health Index (NHI) number will be recorded by the technician and stored in the B4 School Check national information system, along with the results of the check. I consent to my child taking part in the B4 School Hearing and Vision Checks.

8. The above arrangements are in effect as long as my child is enrolled in Happy Turtle Childcare, or unless I notify the Centre in writing of my change of mind.

Parent/Guardian Signature: _______________________

Date

General

§ Policy Statement: Happy Turtle Childcare has a number of policies that set out the procedures that are in place for the care and education of the children who attend. The policies folder is available at reception, and 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 handbook as it covers such things as fee details, subsidies that are available to you and ways in which we can help you and your child settle into the service.

§ Child’s strengths, interests, and preferences: Please tell us about your child’s strengths, interests, and preferences.

§ Transitional School Visits: Information on transition arrangements.

§ Correspondence School Enrolment: Details of enrolment agreement.

§ Fee Schedule and Terms & Conditions: Please ensure you have read the Fees Schedules and their Terms & Conditions before signing this form. Feel free to ask about 20 free ECE hours or WINZ subsidies that may be available for your child/ren. By signing this enrolment form, I agree to the terms of trade of Happy Turtle childcare and understand that any cost incurred in the recovery of overdue fees with penalty interest will be payable by me.

Parent/Guardian Signature: _______________________

Date

Terms and Conditions

1. I agree to pay all the tuition fees weekly in advance as per the Centre’s current Fees Schedule or as revised with a due notice from time to time and other dues payable to Happy Turtle Childcare Centre Papakura Ltd t/a Happy Turtle Childcare, and to pay the fees even if the child is absent from the Centre for being sick or for any other reason including Statutory Holidays, as per the Centre’s Policies.

2. I agree that the enrolled days cannot be swapped, even if it is a holiday on an enrolled day, and you must give at least 2 weeks written notice to make any changes to your child’s enrolment.

3. I agree to inform the Centre, if my child is going to be absent and for any absence of more than 3 days a medical Certificate will be required from your doctor, as per the Ministry of Education requirement.

4. Your child is eligible for 2 weeks holiday for over 1 year. During the holiday period the charge will be 50% of your normal fees. You must give 2 weeks’ notice prior to the holiday.

5. I agree to give at least 2 weeks written notice for termination of my child’s enrolment or will have to pay two weeks’ fees in lieu.

6. I understand and agree that my child has to attend Happy Turtle Childcare for the number of days and hours that he/she is booked for, and in the case of frequent absence or less hours of attendance penalties will occur and be payable by me.

7. I agree with the Terms and Conditions of the enrolment of my child, and this is a binding contract between Happy Turtle Childcare (the Provider of Service under its trade name above) and the signatory of this contract.

8. I authorised the Centre to show and communicate all the information in these forms to their associates, authorised representatives of the Ministry of Education, Auditors, Review Authorities, and the Staff of the Centre.

9. The Centre practices a strict Privacy Policy Act 2020 to safeguard the information provided to them, however, we cannot be held responsible for any Staff or other person in breach of their confidentiality agreement or irresponsible use of information.

10. I confirm that I have read and understood the policies set forth in Happy Turtle Childcare, fees schedule and Terms of Trade. I accept all the terms and conditions contained in all these policies.

11. I agree to pay outstanding fees to the Centre by the due date and that if I fail to do so, it may result in the suspension of the child’s enrolment, and I will be liable to pay debt collection costs and 10% interest on top of outstanding fees.

12. Please ensure you have read and understood the information in the Parent Handbook provided.

13. Please make sure no valuables are worn by your child/children while attending Happy Turtle Childcare. However, we discourage the wearing of items around the neck, wrists, or body at sleep time due to safety reasons. For significant cultural necklaces (hei taonga) and amber beads discussions need to take place with the parents/guardians to see what practice takes place at home. Written permission must be provided by parents/guardians in order to leave these on their child while sleeping.

14. I understand that Happy Turtle Childcare is a NUT FREE ZONE.

15. I understand and agree that there are CCTV cameras in parking and outdoor areas always operating for the security and protection of staff, children, and property.

Parent/Guardian Signature: _______________________

Date

Parent Declaration

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

Parent/Guardian Signature: _______________________

Date

Service Declaration - Office Use Only

On behalf of Happy Turtle Childcare Centre Papakura Ltd t/a Happy Turtle Childcare, I declare that this form has been checked and all relevant sections have been completed.

Service Provider Name: _______________________

Service Provider signature: _______________________

Date

 Photo ID Details of Parents Sighted and Copied

 Child’s Birth Cert/Passport Sighted and Copied

 Well Child Book Sighted and Copied

 Individual Health Plan completed and signed.

 Immunisation Register Signed by Parent

 20 ECE Hours Attestation completed.

Enrolment Type: FT / PT / ECE20 FT / SESSION:

q Admin fee Paid: $ 55.00

q By Eftpos /Auto/Cheque/Cash Receipt #. Weekly Fee Amount: $.

Manager: Comments:

Documents Required for Enrolment
 Birth Certificate or Passport
 Immunisation Record
 Photo ID of Parents
 Others (Please Specify)