Application Form

Out of School Hours Care

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.

Step 1 of 7

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*
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*
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

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.
Consent*
I give permission for my child to be taken from the Service for regular excursions throughout the school term 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 if I wish to see it.
Child's Name*
First Middle Last
Your Name*
First Last
Signature*
Today's Date
DD slash MM slash YYYY

Here’s what parents are saying.

Parents Comments

Kate & Andrew

Parents

“I just wanted to take a moment to thank you and all of the wonderful staff at Rainbow for the care you provide Ivy and Leo.

Over the past year Ivy has flourished under the care of the amazing carers in the Pippi room. She adores coming to daycare, it is one of her happy and safe places. She has made many friends, particularly over the past few months and we are delighted with how happy and content she is in the environment.

I would also like to give thanks to the carers in the Possum room for the kindness and support they have provided to Leo.

Finally, I would like to thank your staff for being an endless wealth of knowledge and support for us throughout the year.“

Caroline & David

Parents

“Our family have had a relationship with Rainbow for nearly 3 years with both our daughters attending the Long Day Care service.

It was an easy decision for us to send our girls to Rainbow – we were drawn to the great outdoor space, the higher than required educator to children ratio, and the number of educators who are qualified early childhood teachers.

It is also a true not-for-profit Childcare Centre with a focus on investing in the children’s education program and service.

We have always found the educators responsive and approachable and to truly care about the children. They work very hard to make the program enjoyable and engaging for the children on a daily basis.

Our eldest daughter has just completed the preschool program and is very confident and well prepared for her transition to Kindergarten. She will greatly miss her Rainbow friends and teachers.

We would highly recommend Rainbow Children’s Centre to other parents.“

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]

Out of School Hours Care

Step 1 of 7

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: