OOSH – Enrolment application Out of School Hours (OOSH) – Enrolment application 1Intro2Child3Health4Family5Pickup / drop off6Agreement You can use this form to Enrol your child in the Out of School Hours (OOSH) program Please note This form must be completed each calendar year A separate form must be completed for each child you wish to enrol Completing this form is not a confirmation of enrolment Who can use this form A parent or guardian who has parental responsibility for the child being enrolled While completing this form, we will request Personal details Centerlink details Medicare details Ambulance details Health details and action plans (document upload may be required) Access / custody arrangements (document upload may be required) It will take about 10 minutes to complete this form. After you submit this form We will send you an email receipt to confirm we have received your application A staff member will be in contact with you to discuss placement Once this enrolment form is complete you can fill in a program booking form What happens with your information? Information requested on this form is required by: Education and Care Service National Law 2010 Education and Care National Regulations 2011 Commonwealth Family Assistance Law Children's Youth and Families Act 2005 We may disclose requested information on this form to the Federal Government Child Care Management System. We will handle any personal information you provide on this form in accordance with the Privacy and Data Protection Act 2014. We record this information on our customer databases and make it available to relevant Council staff in line with our Privacy Statement. You can access your personal information by contacting our Privacy Officer. Child Care Subsidy (CCS)Have you applied for Child Care Subsidy?(Required) Yes No BEFORE COMPLETING THIS FORMPlease contact Centrelink to apply for Child Care Subsidy, you will need to register each child for CCS. Visit the Centerlink website for more informationName of parent / guardian claiming CCS(Required)Child's Centrelink CRN(Required)Customer Reference Number (CRN) is supplied by Centrelink. Please note parent and children have different CRN numbers.This field is hidden when viewing the formAgeEnrolment yearWhich year do you which to enrol your child in the OOSH program?(Required)If your child is already attending this year you will only need to select next year.A new enrolment application must be completed each year. Select all that apply 2026 Child's detailsSurname(Required)Given name/s(Required)Date of birth(Required) Country of birth(Required)Gender(Required) Male Female Other Aboriginal/Torres Strait Islander descent(Required) Yes No Child’s residential address(Required)Child’s postal address(Required)Child’s postal address same Same as residential address Who does this child usually live with?(Required)▾Parents or parent and partnerMotherFatherOtherPlease specify who the child lives with(Required)Ethnic group/cultural identity(Required)Child’s primary language(Required)Other languages spoken or understoodEducationSchool enrolled(Required)Did your child attend kindergarten in 2025?(Required) Yes No We require a copy of your child's transition statement(Required) I have a copy of transition statement to upload on this form You have my permission to contact the kindergarten for the transition statement Upload a copy of your child's transition statement Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 3 MB, Max. files: 1. Name of kindergarten(Required)Phone number of kindergarten(Required)Add area code for landline numbers e.g 03Help us get to know your childMy grade is...(Required)My family/carers consist of...(Required)My family culture is...(Required)My family speaks...(Required)My favourite meal is...(Required)I am really good at...(Required)I like to play...(Required)Outside of school, I like to...(Required)I need help with...You can help me by...Something I think you may like to know about me is...(Required) Child's healthDoctorDoctors clinic(Required) Swan Hill Primary Health (54-56 McCrae St Swan Hill - 5033 9900) Mallee District Aboriginal Services (70 Nyah road Swan Hill - 5032 8600) Other Name of clinic(Required)Address of clinic(Required)Phone number of clinic(Required)Add area code for landline numbers e.g 03Name of Doctor(Required)'Any doctor' is acceptableMedicareDo you have an Australian medicare card?(Required) Yes No Child's medicare card number(Required)REF is the number next to your child's name on the cardAmbulanceDo you have ambulance coverage?(Required) Yes No Ambulance fund membership number(Required)Administration of medicationDoes your child require regular administration of medication?(Required) Yes No Medication name(Required)Times medication is required to be administered(Required)Reason for medication(Required)AnaphylaxisHas your child been diagnosed as anaphylactic(Required) Yes No Anaphylaxis: Causes and triggers(Required)Anaphylaxis: Signs and symptoms(Required)Medication MUST be provided and will be kept at the program.Upload your child's Anaphylaxis Action Plan. This document must be signed by your doctor.(Required) Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 3 MB, Max. files: 1. AsthmaDoes your child suffer from Asthma?(Required) Yes No Asthma: Causes and triggers(Required)Asthma: Signs and symptoms(Required)Medication and spacer MUST be provided and will be kept at the program.Upload your childs's Asthma Plan. This document must be signed by your doctor.(Required) Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 3 MB, Max. files: 1. Food allergies and dietary needsDoes your child have any food allergies or sensitivities?(Required) Yes No What food/s is your child allergic to?(Required) Cow’s milk (dairy) Soy Egg Wheat (Gluten) Fish Crustacea Molluscs Sesame seed Peanut Tree Nuts: Almond Tree Nuts: Cashew nuts Tree Nuts: Pistachio nuts Tree Nuts: Hazelnut Tree Nuts: Macadamia Tree Nuts: Pinenut Tree Nuts: Pecan Tree Nuts: Walnut Tree Nuts: Brazil nut Other Other food allergies:(Required)What milk substitute does your child eat or drink?(Required)Please list product namesWhat replacement breakfast cereals, breads, crackers, or other grain products does your child eat?(Required)Please list product namesWhat egg replacer does your child use?(Required)Please list product namesAre there any other replacement foods your child eats?Please list product namesFood labels: Is there specific label warnings that you avoid?e.g. may contain traces of nuts. Please be specific to avoid confusion.Is there any information we need to be aware of when preparing food for your child?Contact with food packaging sensory play: As we do lots of recycled craft and sensory play at our program will your child be able to encounter this product physically?Does your child have any special dietary needs?e.g. food intolerances, vegetarian, cultural, other special medical dietsBreakfast: What foods does your child prefer to eat ?(Required)Morning tea: What foods does your child prefer to eat ?(Required)Lunch: What foods does your child prefer to eat ?(Required)Afternoon tea: What foods does your child prefer to eat ?(Required)Other allergiesDoes your child have any other allergies or sensitivities?(Required) Yes No Provide details of allergy or sensitivity(Required)Upload allergy management plan (if needed) Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 3 MB, Max. files: 1. Sun screen and insect repellentDo you consent to your child being applied with sunscreen and insect repellent as deemed appropriate by educators?(Required) Yes No You will need to supply your own sunscreen and insect repellent that is suitable for your child to use.Other medical conditionsDoes your child have any other relevant medical conditions?(Required) Yes No Provide details of medical conditions(Required)Upload managment plan (if needed) Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 3 MB, Max. files: 1. DevelopmentDoes your child have special needs, a developmental delay or disability including intellectual, sensory or physical impairment?(Required) Yes No Please select all that apply(Required) Hearing Sight Physical Intellectual Speech Behaviour Other Please explain what this means for your child(Required)Upload a management procedure (if needed) Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 3 MB, Max. files: 1. IllnessesHas your child had any of the following illnesses? Measles Mumps Rubella Chicken Pox Other Provide details of illnesses(Required)ImmunisationAre your childs immunisations up to date?(Required) Yes No Do you intend for your child to be fully immunised?(Required) Yes No Do you have any comments about your childs immunisation?PhotosDo you consent to your child being photographed for evidence of learning experiences, assessment and rating purposes and images or videos being taken, stored, deleted or destructed whilst attending the Out of School Hours Program?(Required) Yes No Do you consent to your child being photographed for service promotional purposes and images or videos being taken, stored, deleted or destructed whilst attending the Out of School Hours Program?(Required) Yes No Additional informationDo you have any other concerns about your child or any other relevant information?What are your child’s interests and hobbies?(Required) FamilyHow many parents / guardians does the child have?(Required) One Two More than two Religious and cultural requirementsDoes your family have any religious or cultural requirements / beliefs?(Required)i.e food preparation, celebrations, etc Yes No Please provide details(Required)Access / custody arrangementsAre there any court orders or parenting agreements relating to the powers, duties, responsibilities or authorities of any person in relation to the child or access to the child?(Required)i.e. Child Custody Arrangements, Restraining Orders, Parenting Orders or Parenting Plans Yes No Please provide details(Required)Upload access / custody arrangement supporting documents(Required) Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, heic, Max. file size: 3 MB, Max. files: 2. Parent / Guardian detailsParent / Guardian 1Surname(Required)Given name/s(Required)Relationship to child(Required)Parent Centrelink CRN(Required)Customer Reference Number supplied by CentrelinkResidential address(Required)Same as child's residential address Same as child's residential address Postal address(Required)Same as child's postal address Same as child's postal address Email address(Required) Phone(Required)Add area code for landline numbers e.g 03Date of birth(Required) Country of birth(Required)Aboriginal/Torres Strait Islander descent(Required) Yes No Ethnic group/cultural identity(Required)Primary language(Required)Other languages spoken or understoodEmployment status(Required)▾Working full timeWorking part timeStudentLooking for workPension or benefitUnemployedOccupation(Required)Work place (business name)(Required)Work phone(Required)Add area code for landline numbers e.g 03Work address(Required)Parent / Guardian 2Surname(Required)Given name/s(Required)Relationship to child(Required)Country of birth(Required)Residential address(Required)Residential address Same as child's residential address Postal address(Required)Postal address Same as child's postal address Email address Phone(Required)Add area code for landline numbers e.g 03Aboriginal/Torres Strait Islander descent(Required) Yes No Ethnic group/cultural identity(Required)Primary language(Required)Other languages spoken or understoodEmployment status(Required)▾Working full timeWorking part timeStudentLooking for workPension or benefitUnemployedOccupation(Required)Work place (business name)(Required)Work phone(Required)Add area code for landline numbers e.g 03Work address(Required)This field is hidden when viewing the formSection BreakAdditional Parent / Guardian OR Authorised PersonAuthorised person Full name Relationship to child Actions Edit Delete There are no Authorised person/s. Add Authorised person Maximum number of authorised person/s reached. At least one person over 18 years of age must be nominated. An authorised person will be used if custodial parents listed on this form are unable to be contacted. An authorised person is able to: pick up your child consent to the administration of medication consent to emergency medical treatment including ambulance transportation approve the taking of your child outside the program venue on outings or excursions Pickup / drop off person/s Pickup / drop off Full name Relationship to child Actions Edit Delete There are no Pickup / drop off person/s. Add Pickup / drop off person Maximum number of pickup / drop off person/s reached. A pickup / drop off person listed above will ONLY have the authorsiation or pick or drop off your child. Agreement Swan Hill Out of School Hours participation agreement I understand the Out of School Hours (OOSH) programs operate in accordance with program policies and procedures, handbook and Education and Care Services National Law Act 2010 and Regulations 2011 and agree to adhere to the requirement of these documents. I agree to pay my account at least fortnightly and understand that failure to do so will result in termination of service. I understand payments can be made by Council's BPAY or directly at Council office. Cash payments are no longer allowed due to government regulations. I understand my BPAY biller code and reference number will be visible on my accounts. I understand that my child can only be picked up from the program by adults as authorised on the enrolment form and that myself and all authorised persons will need to set up an individual electronic pin for the purpose of signing my children in and out of care, this pin is not to be shared or used by others. If I require a person who is not authorised on the enrolment form to collect my child I must notify the program of the persons name, phone number and relationship to the child and the person must provide photo identification upon collection of the child. I agree that if my child is to be absent from the program, I will telephone 0409 236 541 to leave a message notifying program educators before program commencement time. I understand that I will be charged for non attendances (absences) on booked days. If I require an additional session at the After School Program for my child, I will telephone 0409 236 541 and speak to an educator to ascertain if a vacancy exists for an additional booking. I agree that I shall give a minimum of one week’s notice of cancellation of permanent bookings, or changes to bookings for After School Care. Bookings are required for Vacation Programs. I understand my vacation bookings cannot be altered after the closing date stated on the booking form and I will be charged for all days booked. I consent to administration of appropriate first aid for my child, the calling of an ambulance and ambulance travel or dental, medical or hospital treatment to be sought by service staff in the event of an accident or emergency affecting my child. I agree to be responsible for any expenses that may be incurred. I will inform program educators if my child contracts any nits, illness or infectious disease which could be detrimental to the health of others at the program. I understand I will be asked to collect my child from the program if he/she displays inappropriate behaviour or becomes unwell while in care. I am willing to abide by the decisions of program educators and understand that I can contact program educators at anytime to make an appointment to discuss the care of my child. OOSH educators collect, record and become aware of personal and health information about each child attending the service and their family. This information includes details of the child and family in relation to health, nutrition, aspects of social, religious, employment, financial, medical and other family circumstances. All information provided is considered to be confidential. I understand that it is necessary to share this information with other educators and staff within the OOSH program. I also understand and consent to educators and staff discussing information that is relevant to service provision. I agree that neither Swan Hill Rural City Council nor its officers or volunteers will be liable for any damage or injury howsoever caused or of whatsoever nature that may be incurred by my child in attendance at any program or any of the activities in connection with the said program. I consent to my child being taken outside the perimeter of the Swan Hill Primary School grounds for the purposes of evacuation and evacuation drills and to participate in walks within one kilometre radius of the Swan Hill Primary School grounds. All information provided is true and correct and identifies contact telephone numbers, allergies, medical conditions, immunisation status and custody arrangements known to me at this time. I will promptly advise service educators of any changes to this information. I consent to my child watching age appropriate PG movies. I agree to not take any images or videos of my child and other children whilst at the Out of School Hours Programs. If I would like a photo of my child I can ask an educator to take it on a program device and send it to me. Agreement(Required) I have read this participation agreement in full and agree to all of these conditions (Required) Full name(Required)Your email address(Required) FOR OFFICE USE ONLY Has this service sighted this child's health records? ☐ YES ☐ NO Staff name: _____________________________________________ Position: ______________________________________________
