Enrolment (embedded)

Child Details

Name your child is known by / preferred name:

Given name

Surname/family name

Child’s official first name

Child’s official last name

Official Middle Name 1

Official Middle Name 2

Birth Date

Gender

Residential Address

Alternative Address

Languages

Ethnicity

IWI

How did you hear about us?

Register

Have you created an enquiry account on our website before, or have another child at the centre?

Please enter your email address and we will load your previous details.

Email

Contact(s)

Parent(s) / Guardian(s)

Add Parents / Guardians

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Forgot Password

Address

Occupation

Birth Date

Emergency contact(s)

Add emergency contact(s) other than Parent/Guardian - must be able to pickup your child.

Emergency Contacts

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Address

Birth Date

Additional contact(s)

Do you have any additional people that can pickup your child? If so, please enter them here and press Next when you are done.

Contact Details

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Address

Birth Date

Pickups prohibited by

Important - are there people who specifically cannot pickup your child? If so, please enter their details here.

Contacts who can not pickup your child

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Address

Birth Date

Please note: A copy of any court document/custody order and details of any custodial arrangements will be required to keep on file for staff to sight.

Health

Child's Doctor

Health

Medicines

Permissions

Please indicate below whether you give permission for your child to:

Enrolment

Child has to be enrolled for a minimum of 2 days.

Please choose the dates and days below. Note the service may require you to enrol a certain number of days.

Start date

Last day

Mon From

Mon To

Mon Ece hrs

Tue From

Tue To

Tue Ece hrs

Wed From

Wed To

Wed Ece hrs

Thu From

Thu To

Thu Ece hrs

Fri From

Fri To

Fri Ece hrs

Sat From

Sat To

Sat Ece hrs

Sun From

Sun To

Sun Ece hrs

Mon Session

Tue Session

Wed Session

Thu Session

Fri Session

Sat Session

Sun Session

STATUTORY HOLIDAYS/ TERM BREAKS

This enrolment agreement is inclusive/exclusive of school term breaks.

If your service is open on Statutory Holidays, parents need to confirm enrolment for each individual statutory holiday.

30090 Eastern Bays Homebased Childcare is open on the following public holidays if they fall on a weekday. Please tick the days you wish your child to be specifically enrolled for: