Application forms

Out of School Hours Care
Enrolment Form

Complete the following application forms for each child you would like to enrol into Rainbow Children’s Centre Out of School Hours Care.

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.

"*" indicates required fields

Step 1 of 7

Permissions & Authorisations

Child Name*

First Middle Last

Gender

Child Date Of Birth*

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*

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*

Work Phone Number

Mobile Phone Number*

Parent 2 Address*

Same as previous 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

Person(s) other than a parent who has consent to authorise or arrange for your child to be transported outside of the service, including authorisation for your child to be taken outside of the service premises or to be taken on an excursion. Under no circumstances will a member of staff provide transportation for a child in their own vehicle, authorise the transportation of children outside the premises, or take a child on an excursion without the parent or the authorised person's consent.

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*

Authorised Consent Person 2 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Name*

First Last

Signature*

Today's Date*

About Your Child's Health

Is your child immunised?*

Yes

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*

Rainbow Childrens Centre Permission to take children from the Centre for Regular Local Excursions

Local Lennox Shops / or Library

Excursion destination: Local Lennox Shops / or Library
Method of Transport: Walking - crossing one quiet laneway.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children.
Proposed learning experiences during the excursion: The children may visit shops, observe local services (e.g. Post Office), watch bread making, go to the cafe and go for a walk as a change to the normal centre program.
Likely length of the excursion: Excursions will be up to one hour.

Lennox Lake

Excursion destination: Lennox Lake.
Risk from water hazards on the excursion: The children are given clear guidelines just before departure re out of bounds and that they are not to enter water.
Method of Transport: Walking - crossing 4 small roads.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children.
Proposed learning experiences during the excursion: The children may collect art materials, explore nature, play games and go for a walk as a change to the normal centre program.
Likely length of the excursion: Excursions will be up to one hour.

Lennox Beach and / or Ballina Street Park

Excursion destination: Lennox Beach and / or Ballina Street Park.
Risk from water hazards on the excursion: The children are given clear guidelines just before departure re out of bounds and that they are not to enter water.
Method of Transport: Walking - crossing 4 small roads.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children. Although that may be varied as staff assess iss children and other circumstances.
Proposed learning experiences during the excursion: The children may collect art materials, explore nature, play games and go for a walk as a change to the normal centre program.
Likely length of the excursion: Excursions will be up to one hour.

Ballina Public School Western Side Playground

Excursion destination: Ballina Public School Western Side Playground.
Method of Transport: Walking - crossing pedestrian crossing.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children.
Proposed learning experiences during the excursion: The children will climb play equipment developing gross motor skills. The children will participate in group games learning cooperation and turn-taking.
Likely length of the excursion: Excursions will be up to one hour.

Fawcet Park Ballina

Excursion destination: Fawcet Park Ballina.
Risk from water hazards on the excursion: The drop off to river is unfenced children to be informed prior to departure about the boundaries.
Method of Transport: Walking - crossing three unmarked streets and one pedestrian crossing.
Numbers of children involved: Groups of up to 30 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children. Although that may be varied as staff assess iss children and other circumstances.
Proposed learning experiences during the excursion: The children to learn about their local community, health and wellness exercise walking to park. Change to the nromal centre program.
Likely length of the excursion: Excursions will be up to one hour.

Local Ballina Shops

Method of Transport: Walking - crossing one quiet laneway.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children.
Proposed learning experiences during the excursion: The children may visit shops, observe local services (e.g. Post Office), watch bread making, go to the cafe and go for a walk as a change to the normal centre program
Likely length of the excursion: Excursions will be up to one hour.

Ballina Library

Excursion destination: Ballina Library.
Method of Transport: Walking - crossing three unmarked streets and one pedestrian crossing.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children.
Proposed learning experiences during the excursion: The children may borrow books for the service on our library card and have some quiet reading.
Likely length of the excursion: Excursions will be up to one hour.

School Hall and Upper Playground on Primary School Site

Excursion destination: School Hall and Upper Playground on Primary School Site.
Method of Transport: Walking - walking the most direct route all paved to hall or playground.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children. Although that may be varied as staff assess iss children and other circumstances.
Proposed learning experiences during the excursion: The children will participate in group physical activities developing gross motor skills, team sports and turn taking.
Likely length of the excursion: Excursions will be up to one hour.

Local East Ballina Shops

Excursion destination: Local East Ballina Shops.
Method of Transport: Walking - crossing one marked crossing.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children.
Proposed learning experiences during the excursion: The children may visit shops, observe local services (e.g. Post Office), watch bread making, go to the cafe and go for a walk as a change to the normal centre program
Likely length of the excursion: Excursions will be up to one hour.

Sharpes Beach

Excursion destination: Sharpes Beach.
Risk from water hazards on the excursion: The children are given clear guidelines just before departure re out of bounds and that they are not to enter water.
Method of Transport: Walking - crossing one unmarked road.
Numbers of children involved: Groups of up to 30-50 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children.
Proposed learning experiences during the excursion: The children may explore shore line build sand castles, play games and go for a walk as a change to the normal centre program.
Likely length of the excursion: Excursions will be up to one hour.

Chickiba Lake and Park

Excursion destination: Chickiba Lake and Park.
Risk from water hazards on the excursion: The lake is not fenced off and children will be informed prior to departure about the boundaries and they are not to enter water.
Method of Transport: Walking - crossing one marked crossing.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children. Although that may be varied as staff assess iss children and other circumstances.
Proposed learning experiences during the excursion: The children may collect art materials, explore nature, play games and go for a walk as a change to the normal centre program.
Likely length of the excursion: Excursions will be up to one hour.

School Library

Excursion destination: School Library
Method of Transport: Walking - Walking the most direct route all paved to Library.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will normally be a ratio of one carer to no more than ten children. Although that may be varied as staff assess iss children and other circumstances.
Proposed learning experiences during the excursion: The children will participate in indoor games, quiet activities and book research.
Likely length of the excursion: Excursions will be up to one hour to 3 hours.

Local nature walks

Excursion destination: Local nature walks Risk from water hazards on the excursion: The lake is not fenced off and children will be informed prior to departure about the boundaries and they are not to enter water.
Method of Transport: Walking within school grounds as well as local surrounding streets, Fredricks Land and Hillcrest Drive.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will be a ratio of approximately one educator to each ten children, although that may be varied as staff assess ISS children and other circumstances.
Proposed learning experiences during the excursion: The children may collect art materials, explore nature, play games and go for a walk as a change to the normal Centre program.
Likely length of the excursion: Excursions will be up to one hour.

School roundabout on Primary School Site

Excursion destination: School roundabout on Primary School Site.
Method of Transport: Children will walk their bikes to the area from bike racks down path to the roundabout.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will be a ratio of approximately one educator to each ten children, although that may be varied as staff assess is children and other circumstances.
Proposed learning experiences during the excursion: To use the space from programmed bike and scooter riding activities.
Likely length of the excursion: Excursions will be up to two hours with continued breaks through out.

Mobile Library located at Roundabout on Primary School site

Excursion destination: Mobile Library located at Roundabout on Primary School site.
Method of Transport: Walking -Walking the most direct route all paved to Mobile Library.
Numbers of children involved: Groups of up to 20 children.
Numbers of educators or other responsible adults required for the excursion: There will be a ratio of approximately one educator to each ten children, although that may be varied as staff assess is children and other circumstances.
Proposed learning experiences during the excursion: To be involved with our surrounding community and build on language & literacy.
Likely length of the excursion: Excursions will be up to 30 minutes.

Child's Name*

First Middle Last

Your Name*

First Last

Signature*

Today's Date

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*

Child's Gender*

Child's CRN*

Aboriginal/Torres Strait Islander?*

Yes

Disability?*

Yes

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

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

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.

4 John Sharpe Street, East Ballina NSW 2478

02 6686 6621

Out of School Hours Care
Enrolment Form

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

Rainbow Childrens Centre Permission to take children from the Centre for Regular Local Excursions

Local Lennox Shops / or Library

Lennox Lake

Lennox Beach and / or Ballina Street Park

Ballina Public School Western Side Playground

Fawcet Park Ballina

Local Ballina Shops

Ballina Library

School Hall and Upper Playground on Primary School Site

Local East Ballina Shops

Sharpes Beach

Chickiba Lake and Park

School Library

Local nature walks

School roundabout on Primary School Site

Mobile Library located at Roundabout on Primary School site

Complying Written Arrangement Offer of Service

Enrolment Information:

Address

Phone Number

Email

Send us a message

Out of School Hours Care Enrolment Form

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

Rainbow Childrens Centre Permission to take children from the Centre for Regular Local Excursions

Local Lennox Shops / or Library

Lennox Lake

Lennox Beach and / or Ballina Street Park

Ballina Public School Western Side Playground

Fawcet Park Ballina

Local Ballina Shops

Ballina Library

School Hall and Upper Playground on Primary School Site

Local East Ballina Shops

Sharpes Beach

Chickiba Lake and Park

School Library

Local nature walks

School roundabout on Primary School Site

Mobile Library located at Roundabout on Primary School site

Complying Written Arrangement Offer of Service

Enrolment Information:

Out of School Hours Care
Enrolment Form