Application Form

Birth – 5 Years Rainbow Education and Care

Complete the following application forms for each child you would like to enrol into Rainbow Children’s Centre educational programs.

Allow 20 minutes to complete each child’s application and keep in mind, some fields will request similar information, this allows multiple forms to be completed at the one time.

Step 1 of 10

Permissions & Authorisations
Child Name*
First Middle Last
Gender*
Child Date Of Birth*
DD slash MM slash YYYY
Child Home Address*
Same as Parent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Email Address*
Enter Email Confirm Email
Parent full names and best contact numbers while child is at the centre (please note parent full name and parent date of birth is required for Child Care Benefit approvals)
Parent 1 Name*
First Last
Parent 1 Date of Birth*
DD slash MM slash YYYY
Work Phone Number
Mobile Phone Number*
Parent 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 2 Name*
First Last
Parent 2 Date of Birth*
DD slash MM slash YYYY
Work Phone Number
Mobile Phone Number*
Parent 2 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permissions & Authorisations - Emergency Contact Person
Person(s) to contact in an emergency (other than parent) who has consent to authorise medical treatment, medications and excursions).
Emergency Contact 1 Name*
First Last
Relationship to Child*
Work Phone Number
Mobile Phone Number*
Emergency Contact 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact 2 Name*
First Last
Relationship to Child*
Work Phone Number
Mobile Phone Number*
Emergency Contact 2 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permissions & Authorisations - Authorised Pickup Person
Persons other than parents authorised to pick up your child at the centre.
Authorised Pickup Person 1 Name*
First Last
Relationship to Child*
Work Phone Number
Mobile Phone Number*
Authorised Pickup Person 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Authorised Pickup Person 2 Name*
First Last
Relationship to Child*
Work Phone Number
Mobile Phone Number*
Authorised Pickup Person 2 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permissions & Authorisations - Authorised Consent Person
Authorised Consent Person 1 Name*
First Last
Relationship to Child*
Work Phone Number
Mobile Phone Number*
Authorised Consent Person 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Authorised Consent Person 2 Name*
First Last
Relationship to Child*
Work Phone Number
Mobile Phone Number*
Your Name*
First Last
Signature*
Today's Date
DD slash MM slash YYYY

Legal Information
Are there any custody orders; residence orders; family court orders; or other matters re custody of your child that affects who has access to the child?*
- Yes
- No
If so, please provide details of any court orders, parenting orders or parenting plans provided by the approved provider relating to powers, duties, responsibilities or authorities of any person in relation to the child or access to the child. Also details of any other court orders provided by the approved provider relating to the child’s residence or the child’s contact with a parent or other person. So that the centre can operate in accordance with the orders, please upload relevant documents.
Upload Files
Drop files here or

Accepted file types: jpg, png, pdf, doc, xls, docx, Max. file size: 128 MB.
Cultural Background or Parents:
Parent 1
Parent 2
Languages spoke in the home
Child's Religion, if Applicable
Are there any cultural or religious preferences that you would like to be brought to the attention of staff?*
Consent*
I agree to Rainbow Children’s Centre Inc privacy policy.
Please review our Privacy Policy here.
Signature*
Todays Date*
DD slash MM slash YYYY

About Your Child's Health
Is your child immunised?*
- Yes
- No
Your child's usual medical practitioner?
Name*
First Last
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your child's usual dental practitioner?
Name*
First Last
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Family Medicare Number*
About Your Child's Health - Continued
Is there any medical/emergency information we should know, e.g. does your child have any recurring illness or condition such as epilepsy or asthma or anaphylaxis? If so, please state the condition and treatment*
please complete an emergency action plan if your child is asthmatic, or has epilepsy or an allergy or anaphylaxis
Is your child on any regular medication, and if so, what kind and for what condition?*
Is there anything we should know about your child’s past medical history (any serious accidents, any trauma’s suffered during or soon after birth)?*
Does your child’s suffer with frequent infections (e.g. ear, nose and throat etc.)?*
Has your child had any allergies to food, drugs, soaps, lotions or insect bites?*
Does he/she have sensitive skin and are there certain soaps, lotions etc. we shouldn’t use on them?*
as your child ever been hospitalised and if so for what reason?*

Permissions and Agreement to Enrol Child
I am aware that I have certain responsibilities to comply with as a parent of the centre and am aware of the need to provide accurate and complete information to the centre, which will allow centre staff to provide appropriate care for my child.

I understand that my child will be excluded from the centre for a period consistent with the recommendations of the NSW Dept of Health if he/she is suffering from any contagious or infectious illness and I must provide a doctors certificate stating that my child no longer presents a risk to any other child at the centre before he/she will be re-admitted.

I agree to provide evidence of my child’s immunisation status and provide relevant updates to ensure my child’s continued enrolment.

I authorise the administration of paracetamol to my child, in accordance with the recommendations of the NSW Department of Health, if it is considered necessary in the event of my child experiencing pain, high temperature or teething whilst at the centre and authorise the centre to apply sun cream, insect repellent or band aids as required by my child.

I agree to apply sunscreen and mosquito repellent on arrival at the service. I understand that staff will reapply every two hours as required.

In the event of an accident, injury or illness, I expect that I will be contacted before any medical attention is given to my child. If I am unable to be contacted, I authorise Rainbow staff to obtain such medical assistance or treatment for my child as may be considered necessary, and for this purpose engage any doctor, nursing assistance, dentist, transportation by ambulance or hospital treatment. In that event I agree to pay any fees or expenses incurred.

I am aware that the centre staff may take photos of my child engaged in everyday educational experiences and positive interactions with other children and staff while in the care of the centre. Some of these photos may be used for publication in the centre brochures, parent handbooks, newsletters, web site photo gallery and display boards in the centre to support the centre’s educational program, promote the service and communicate to families the value of play and education. I authorise the use of my child’s photos for the purposes described.

I am aware that the centre staff may take photos of my child engaged in everyday educational experiences and positive interactions with other children and staff while in the care of the centre. Some of these photos maybe used for publication on our Social Media pages. I authorise the use of my child’s photos for the purposes described.

I understand that the centre does not provide nor endorse any babysitting arrangements with Rainbow staff outside the premises or hours of operation of the centre.
Childs Name*
First Middle Last
I agree to the above conditions for the enrolment of my child at Rainbow Children"s Centre.
Your Name*
First Last
Signature*
Todays Date*
DD slash MM slash YYYY

I give permission for my child to be taken from the centre for routine excursions in the local community under the appropriate supervision of the staff, and within the Education & Care Services National Regulations 2011. I recognise that a risk assessment for the excursion has been prepared and is available at the service desk if I wish to see it.
Childs Name*
First Middle Last
Your Name*
First Last
Signature*
Todays Date*
DD slash MM slash YYYY

Complying Written Arrangement Offer of Service
Child's Name*
First Middle Last
Child's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Child's Date of Birth*
DD slash MM slash YYYY
Child's Gender*
Child's CRN*
Aboriginal/Torres Strait Islander?*
- Yes
- No
Disability?*
- Yes
- No
If yes, what type of disability?
Language/s spoken in the home?*
Siblings at other service?*
Person making the claim for Child Care Subsidy and accepting responsibility for payment of fees to Rainbow Children’s Centre Inc.
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Alternative Phone Number
Email Address
Parent/Guardian CRN
Date of Birth
DD slash MM slash YYYY
Enrolment Information:
Rainbow Education and Care Routine Enrolment Centre Based Care
Please Select
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Casual Enrolment will be requested and made available on an as needed basis. I understand I am responsible for payment of fees for absences on routine enrolments including long term absences up to 8 weeks. Centre Based Care Session times: Start 7.10am Finish 6.20pm
Start Date
DD slash MM slash YYYY
Third Party responsible for payment of fees
Name
First Last
Phone Number
Email Address
Childcare Subsidy - Please ensure you register and accept the Complying Written Agreement at myGov Centerlink. Child Care Subsidy cannot be claimed until you have accepted and signed the Complying Written Agreement and entered these detail at myGov Centerlink. I agree to pay child care fees as per Rainbow Children’s Centre Inc. fee schedule. The fee schedule is advised on our website https://rainbow.nsw.edu.au and in our Family Information Handbook. I understand that the fee schedule may change with 30 days notice.
Name
First Last
Signature
Today's Date
DD slash MM slash YYYY
On behalf of Management Committee Rainbow Children’s Centre Inc.

About My Child & Family
This information is collected to assist us to provide high quality care and education to your child. The information will be placed in your child’s developmental file and will be available to members of our staff team.
Child's Name*
First Middle Last
Date of Birth*
DD slash MM slash YYYY
Gender*
Parent 1 Name*
First Last
Parent 1 Occupation
Parent 1 Place of Work
Parent 1 Work Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 1 Work Phone Number
Parent 1 Hours of Work
Parent 1 Email Address
Parent 2 Name*
First Last
Parent 2 Occupation
Parent 2 Place of Work
Parent 2 Work Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 2 Work Phone Number
Parent 2 Hours of Work
Parent 2 Email Address
Who lives in child’s home (please list all people who live in the home)?*
Names & ages of other children in family:*
Parent 1*
Parent 2*
Languages spoken in the home?*
Are there any cultural or religious preferences that you would like to be brought to the attention of staff?*
Child’s religion (if applicable)
About Your Child
What would you want your child to gain from coming to our centre?*
How does your child relate to other children and adults (relatives, neighbours?)*
How does your child relate to other children and adults (relatives, neighbours?)*
Has your child been in group care previously (e.g. playgroup/ child care/ family day care)?*
Do you encourage your child to feed him/herself? If so what utensils do they use ? What sort of cup? Are they are big or small eater ?*
Does your child drink from a bottle ? Is this milk, formula, breast milk or other?*
Are there any foods or liquids you don’t want him/her to have, or any special likes or dislikes with food or drinks?*
Does your child have a special security toy that they like to carry around?*
Do they become really distressed when they are crying?*
How do they like to be comforted when they are crying? Is there anything they like to have when they are crying like a certain toy or a blanket, etc?*
Do they sleep on their back, or tummy or side? Do they sleep morning and/or afternoon?*
Do they have any difficulties sleeping (e.g. settling, nightmares)? Do they wake when they are wet or soiled? Do they wake at any stage and play, then go back to sleep?*
Are they still in nappies? Are there any problems you would like to mention?*
Have you tried before to toilet train them, if so, how did it go?*
Do they still wear nappies when they have a sleep?*
What activities does he/she particularly enjoy or play at home?*
Are there any activities you would particularly like them to be involved in?*
Is there any other information you consider carers should know about your child?*

Food Choices
Please fill in this section if your child has any food allergies/choices
Child's Name
First Middle Last
I agree that my child can be offered the full menu while attending the centre?
- Yes
- No
Some children may have foods they cannot eat for religious or cultural reasons. I do not want my child offered the following foods due to cultural or religious reasons.
If your child requires a restricted menu you must provide documentation from a medical practitioner, nutritionist or naturopath stating that fact. Restricted menus will not be provided without the appropriate documentation. Children with known allergic reactions or Anaphylaxis need to have an emergency allergic reaction treatment plan completed by a medical practitioner in the event of an emergency.
I do not want my child to be offered any dairy based produce within the menu while at the centre. I want my child to receive dairy free alternatives to milk, yoghurt, cheese etc
Upload Treatment Plan and other Related Documents
Drop files here or

Accepted file types: doc, pdf, docx, xls, jpg, png, Max. file size: 128 MB.
I do not want my child to be offered wheat based produce within the menu while at the centre. I want my child to receive a gluten free alternative to breads, cakes, pasta, cereal etc.
Upload Treatment Plan and other Related Documents
Drop files here or

Accepted file types: doc, pdf, docx, xls, jpg, png, Max. file size: 128 MB.
Some children may have allergic reactions to other foods, please list any specific food that your child cannot eat.
Upload Treatment Plan and other Related Documents
Drop files here or

Accepted file types: doc, pdf, docx, xls, jpg, png, Max. file size: 128 MB.
If your child has high dietary requirements in relation to the above information please see the kitchen staff to complete additional documentation. This will support us to meet your child’s dietary needs.
Today's Date - Form Completion Date
DD slash MM slash YYYY
Signature

Daily routine for:
Child's Name*
First Middle Last
Child's Date of Birth*
DD slash MM slash YYYY
Parent 1 Name*
First Last
Parent 2 Name*
First Last
Health details (existing illness, allergies, chronic conditions)
How is your child best comforted:
Specific Sleep times:
Sleeptime 1
Sleeptime 2
Sleeptime 3
Does your child have a Dummy?
Specific Comfort item?
Is your child self settled or patted to sleep?
Is your child breastfed?
Specific times and ml for bottles (formula, cow’s milk or other alternative):
Bottle Time 1
Bottle Time 2
Bottle Time 3
Food preference (puree, mash, finger food etc):
Food likes and dislikes:
Today's Date - Form Completion Date*
DD slash MM slash YYYY
Signature*
Name
First Last

Here’s what parents are saying.

Parents Comments

Tim

Parent

“My daughter has attended Rainbow for the past two years. The staff are amazing. They have supported her development and are super friendly. I would highly recommend Rainbow.”

Hogan L

Parent

“The carers are fantastic with the children.”

Get in Touch. We look forward to hear from you soon

Contact Details



Address

4 John Sharpe Street, East Ballina NSW 2478.

Phone

02 6686 6621



Email

[email protected]

Birth – 5 Years Rainbow Education and Care

Step 1 of 10

Permissions & Authorisations

Permissions & Authorisations - Emergency Contact Person

Permissions & Authorisations - Authorised Pickup Person

Permissions & Authorisations - Authorised Consent Person

Legal Information

Cultural Background or Parents:

About Your Child's Health

About Your Child's Health - Continued

Permissions and Agreement to Enrol Child

Complying Written Arrangement Offer of Service

Enrolment Information:

About My Child & Family

About Your Child

Food Choices

Daily routine for: