Microsoft word - summer 2010 registration form-hills district.doc
VACATION FUN ENROLMENT FORM 16/12/10-28/01/11
For staffing & food purposes, we ask that you complete this form by no later than 23rd December 2010, and hand it to your Centre Supervisor or fax to 02 8905 9279 or email to [email protected] General/Account enquiries: 1300 553 583 Fax: 02 8905 9279 Email: [email protected] LOCATION/CONTACT DETAILS Please tick the Centre your child/children will be attending
Crestwood Vacation Fun Mowbray Vacation Fun
You will need to contact Centrelink to link your child to the vacation care centre to be able to receive the CCB fee reduction. PROGRAM Packages – WOW! We have great packages available: Pre Christmas $ 45.00 per day Keen Fifteen 15 days $ 810.00 The Perfect Ten The Five Jive One for fun $50.00 per day $75.00 per Excursion day. Please tick the days that your child/children will be attending:
ENROLMENT PROCEDURE: Complete the enrolment form, and either:
Post: PO Box 8239, Baulkham Hills, NSW 2154
In person: Hand it in to one of our Centres
FEES: $50 per standard day. $75.00 per excursion day Once the enrolment form is received at Head Office and the booking has been confirmed, the whole amount will be deducted on Tuesday 21st December and we will be unable to issue any refunds. CHILD CARE BENEFIT We must have a copy of your current assessment notice from the Family Assistance Office before we can apply the Child Care Benefit to your enrolment fees. COURT ORDERS If your child is affected by court orders, please attach a copy to this enrolment form, and a photograph of any person/persons who are refused access to your child/ren LATE FINES If your child has not been collected from the centre by 6pm, a late fee of $5.00 per minute will be charged. PAYMENT DETAILS Total Number of Days / Package Name …………………. OPTION 1: Direct Debit Payment Child/Children’s Name:…………………………………………………………………………………………………… I…………………………hereby give Cubbyhouse Childcare Australia permission to deduct $.from my bank account for the Vacation Care commencing………………………………………………………………… Account Name:………………………………………………… Financial Institution………………………………… BSB (6 digits) __ __ __ __ __ __ Account No:…………………………………………………………………… Name:……………………………………………… Signature…………………………………………………………. Daytime contact No:…………………………………… Date:…………………………. OPTION 2: Credit Card Payment
Child/Children’s Name:…………………………………………………………………………………………………… I hereby consent to Cubbyhouse Childcare Australia to deduct fees from my Credit Card account. (A 3% surcharge will be levied on every transaction) BankcardMastercardVisa Cardholders name:……………………………………………… Phone:……………………………………………… Credit Card Number: Expiry Date: Amount $ Signature……………………………………………. Date:……………………………. www.vacationfun.com.au Amex Expiry Date:
Amount
Signature……………………………………………. Date:……………………………. TERMS OF ENROLMENT Photos and videos may be taken for display, accreditation and advertising purposes at the Centre. Parents consent to such is given when parents sign this form. Please provide children with morning tea and lunch. Afternoon tea will be provided. Hats, sunscreen and suitable footwear must be worn before outdoor play is permitted. There will be in-house entertainment organised at an additional cost per child per activity. It is compulsory to attend the entertainment and I agree to my child’s participation. Please do not bring skateboards, bikes, skates etc. No responsibility will be taken for lost or stolen items. According to new State guidelines, copies of immunization records are necessary for children. In an event of an emergency, accident or illness concerning my child and the Centre staff not being able to contact me or the other person so authorised by me, I consent to the Centre seeking on my behalf, medical or hospital attention for my child and I accept financial responsibility for expenses incurred. I understand that children with a contagious disease will not be accepted. NO FOOD CONTAINING PEANUT PRODUCTS OR TRACES OF PEANUTS ARE TO BE TAKEN INTO THE CENTRE Signed:……………………………………………. Date:…………………………. GENERAL INFORMATION
Child’s (1) name:…………………………………………………………….DOB:………………….School:…………………… Child 1 CRN:…………………………………… Child’s (2) name:…………………………………………………………….DOB:………………….School:…………………… Child 2 CRN:…………………………………… Child’s (3) name:…………………………………………………………….DOB:………………….School:…………………… Child 3 CRN:…………………………………… Address……………………………………………………………………. Mother’s name:…………………………………. ……………………….Ph:……………………. .Mob…………………………. DOB ___/___/____
CRN:……………………………………
Father’s name:………………………………………. …………………Ph:……………………… Mob…………………………. DOB___/___/____
CRN:……………………………………
Mother’s wk ph:………………………………………………………….Father’s wk ph:…………………………………………. Preferred email:…………………………………………………………………………………………………………………………. Expected daily arrival:…………………………………………………. Departure………………………………………………. Please state if there are any custody orders (and if so, please attach a copy) …………………………………………………………………………………………………………………………………………… Please state any religious or cultural requirements we need to abide by whilst caring for your child …………………………………………………………………………………………………………………………………………… Are there any activities in particular that your child enjoys? …………………………………………………………………………………………………………………………………………. EMERGENCY CONTACTS/DETAILS www.vacationfun.com.au
If we cannot contact in the case of an emergency, who do you wish us to call? 1. Name:…………………………………………. Relationship……………………. Phone:…………………… 2. Name:…………………………………………. Relationship……………………. Phone:…………………… 3. Name:…………………………………………. Relationship……………………. Phone:…………………… MEDICAL DETAILS
Please note if there are any medical details or allergies the Centre Supervisor should be aware of: (Please attach action plans) …………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………… …………………………………………………………………………………… Medicare Number:……………………………………………. Doctor:…………………………………………………………. Ph:……………………………………………… Do you give the Centre authority to call an ambulance? YES/NO NOTE: If your child requires Ventolin or an Epi-Pen, a permission note and the medication must be supplied by the parent. It is our policy that under no circumstances can any medication (excluding Ventolin and Epi-Pen) be brought into our Service for children to either administer themselves or be assisted by staff. If your child is found to have medication on them you will be contacted immediately to come and collect the child and the medication.
INDIVIDUAL HEALTH PLAN- Vacation Care
Child’s name:___________________________________
Medical History:
Introduction GOLD 2006 PRESENTATION Tertiary bis-phosphines of the form R P-(CH ) -PR (n = 1 – 4 and R = Me, Et, t-Bu and Ph) and cis-R PCH=CHPR (R = Ph) are often used as chelating ligands for a wide range of transition metals.[1-4] These ligands have shown wider applications in metal complexation reactions and have attracted much attention, especially in the fields of medicine and cat
Diabetes and Dyslipidemia Master DecisionPath Master DecisionPath: Primary Lipid Targets At Presentation LDL <100 mg/dL (<70 mg/dL with evidence of CVD); TRI <150 mg/dL; HDL >40 mg/dL men, >50 mg/dL women Secondary Lipid Targets Non-HDL <130 mg/dL (<100 mg/dL with evidence of CVD) 1. Fasting lipid Apo B <90 mg/dL (<80 mg/dL with evidence of CV
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