enrolment form - adam & noah early learning...

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Adam & Noah Early Learning College Enrollment Form updated Sep 2019

Enrolment Form

I

ENROLMENT FORM

Child Information

Child’s Surname: ............................................................ Child’s Given Names: ................................................

Address: ...........................................................................................................................................................

Preferred Name/s: ........................................................ Child’s CRN: ...............................................................

DOB: ....................................... Age: .........................Gender M F Are you of Aboriginal or Torres Strait Islander Origin

Proposed Start Date: ..............................................................................................

Days required: (please tick) □ Monday □ Tuesday □ Wednesday □ Thursday □

Friday (Min 2 Days) 0y - 6: $110 per day Vacation Care $55 per day •Initial start up fees include a one off enrolment fee of $150.•Fees are to be paid two weeks in advance plus your current week’s gap.

Outside School Hours Care (school aged only) Morning: (please tick) Monday Tuesday Wednesday Thursday Friday Fee$18 per session Afternoon: (please tick) Monday Tuesday Wednesday Thursday Friday Fee: $22 per session

Proposed Start Date: ..............................................................................................

School attending: …………………………………………………………………………………………..

Year /level: ………………………………………………………………classroom: ..................................................................

Booking Information To ensure that you are linked to our Adam & Noah Early Learning College through the Child Care Management System (‘CCMS’) and to have Child Care Subsidy (‘CCS’) applied to your child care fees, you must contact Centrelink to confirm that they have the correct name and date of birth for both the Parent and child who are registered for CCS.

Please complete the following information accurately to ensure that your CRN is linked to our College and to enable you to receive CCS.

For more information contact FAO (Family Assistance Office) on 13 61 50 (8am – 8pm Monday to Friday)

Contact Details for the Child’s Parents or Guardians

Primary Account Holder (NB: The Family CRN should be linked to the Parent/Guardian who is registered with Family Assistance Office.) Title: (Dr / Mr / Mrs / Ms / Miss)

Full Name: ..........................................................................................................................................................

Other name/s: ................................................................. CRN: .........................................................................

Relationship to the child: .............................................(E.g. Mother / Father / Guardian / Other) DOB: .....................................

Driver’s Licence Number: ..........................................................................................

Address: .....................................................................................................................................................................................

Home Phone: ..................................................................... Mobile: ..........................................................................................

Employer Name: …...............................................................................................................................................................

Employer Address: …..................................................................................................................................................................

Work number: ......................................................... Email: ........................................................................................................

Authorised to Collect the Child? Yes No

II

Parent Consent to medical treatment:

I authorise the consent to the medical treatment of my child, for the approved provider, a nominated supervisor or an educator to seek—

(i) medical treatment for the child from a registered medical practitioner, hospital or ambulance service; and

(ii) transportation of the child by an ambulance service; and

(iii) if relevant, an authorisation given under regulation 102 for the education and care service to take the child on regular outings.

(iv) any person who is to be notified of an emergency involving the child if any parent of the child cannot be immediately con-tacted; and

(v) any person who is an authorised nominee.

Note.

Authorised nominee means a person who has been given permission by a parent or family member to collect the child from the education and care service or the family day care educator. See section 170(5) of the Law.

Parent Name ________________ ______________________ Signed___________________________ Date

Secondary Account Holder

Full Name: ..........................................................................................................................................................

Other name/s: ................................................................. CRN: .........................................................................

Relationship to the child: ............................................ (E.g. Mother / Father / Guardian / Other) DOB: ................................

Driver’s Licence Number: ..........................................................................................

Address: .....................................................................................................................................................................................

Home Phone: ..................................................................... Mobile: ..........................................................................................

Employer Name: ….....................................................................................................................................................................

Employer Address: …..................................................................................................................................................................

Work number: ......................................................... Email: ........................................................................................................


Parent Consent to medical treatment:

I authorise the consent to the medical treatment of my child, for the approved provider, a nominated supervisor or an educator to seek—

(i) medical treatment for the child from a registered medical practitioner, hospital or ambulance service; and

(ii) transportation of the child by an ambulance service; and

(iii) if relevant, an authorisation given under regulation 102 for the education and care service to take the child on regular outings.

(iv) any person who is to be notified of an emergency involving the child if any parent of the child cannot be immediately con-tacted; and

(v) any person who is an authorised nominee.

Note.

Authorised nominee means a person who has been given permission by a parent or family member to collect the child from the education and care service or the family day care educator. See section 170(5) of the Law.


III

Additional Authorised Nominee contact 1

Title: (Dr / Mr / Mrs / Ms / Miss)

Full Name: ............................................................................................................................................................

Other name/s: ................................................................. CRN: ...........................................................................

Relationship to the child: .............................................................................. (E.g. Mother / Father / Guardian / Other) DOB: ........................................................ Driver’s License Number: .............................................................

Address: ....................................................................................................................................................................

Home Phone: ..................................................................... Mobile: ...................................................................

Email: ............................................................................................................................................................................


The above person is authorised to:

(iv) consent to medical treatment of, or to authorise administration of medication to, the child

Yes No

(v) is authorised to authorise an educator to take the child outside the education and care service premises;

Yes No



Additional Authorised Nominee contact 2

Title: (Dr / Mr / Mrs / Ms / Miss)

Full Name: ............................................................................................................................................................

Other name/s: ................................................................. CRN: ...........................................................................

Relationship to the child: .............................................................................. (E.g. Mother / Father / Guardian / Other) DOB: ........................................................ Driver’s License Number: .............................................................

Address: ....................................................................................................................................................................

Home Phone: ..................................................................... Mobile: ...................................................................

Email: ............................................................................................................................................................................


The above person is authorised to:

(iv) consent to medical treatment of, or to authorise administration of medication to, the child

Yes No

(v) is authorised to authorise an educator to take the child outside the education and care service premises;

Yes No



IV

FAMILY DETAILS

If you have other children who are registered for CCS at another service, please complete the following information to ensure that you have the Multiple Child CCS Percentage applied to your account. As this information may change, we will ask you for updates periodically throughout the year to ensure the correct CCS percentage is applied.

1. Name: .................................................................... DOB: ……../..……/…….... CRN: ………………………………

2. Name: .................................................................... DOB: …....../.....…/……..... CRN: ………………………………

3. Name: .................................................................... DOB: ……../........./....….... CRN: .………………………………

4. Name: .................................................................... DOB: ……../........./......... . . CRN: ………………………………

Please fill out the above information to ensure you are receiving all your Child Care Benefit entitlements.

SCHOOL AND CULTURAL INFORMATION Does this child usually attend school? Yes No

When was, or when will this child be enrolled at school? ...........................................................................................

Child’s Nationality: .................................................................... Cultural Background: ...................................................

Languages spoken by the child: ...............................................................................................................................................

Languages spoken at home: .......................................................... Child’s Religion: .....................................................

Does your child have any religious or cultural requirements? Yes No (Please include any dietary restrictions)

Details: ............................................................................................................................................................................

CHILD CUSTODY INFORMATION

If Parents are separated and /or divorced, is there a court order specifying who has custody of/or access to thechild? No (go to the next section) Yes ( you must provide a copy of any court order before enrolment )

Name of Custodial Guardian : …………………………………………………………………………………………………………

Is There a court order inplace

Any additional information about access arrangements or court orders:

………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………

Please supply the College with copies of Court Orders, Parenting order, Parenting Plan or Access Arrangements that are in place for your child.

V

MEDICAL INFORMATION

Child’s Medicare Number:

Medicare Expiry Date:

Do you have private health insurance? Yes No (please complete the following)

Fund Name: ......................................................................... Member Number: ..........................................................

Type of Cover: ...................................................................... Level of cover: ...............................................................

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Family Doctor’s Name: .................................................. Family Doctor’s Telephone: ..................................................

Family Doctor’s Address: ...............................................................................................................................................

Preferred Hospital in Emergency: .................................................................................................................................

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Family Dentist Name: ...................................................... Family Dentist Telephone: .................................................

Family Dentist Address: ................................................................................................................................................

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IMMUNISATION DETAILS

To be eligible for Child Care Subsidy, your children must meet the immunization requirements if they are under the age of seven. To meet the requirements, your child must be:

Fully immunized or up---to---date according to the Australian Standard Vaccination Schedule; orOn a catch---up vaccination schedule; orYou have an approved exemption for your child (see below).

Your child is exempt from the immunization requirements in the following circumstances: you have been told by your doctor about the benefits and risks of immunizing your child and you have a conscientious

objection to immunizing your child – your child’s doctor or a recognized immunization provider will need to complete a ‘Medical Contraindication’ form; or

immunizing your child with a particular vaccine is medically contraindicated; orThe child has a natural immunity to a disease or a vaccine is temporarily unavailable; oryou or your partner are a member of the Church of Christ Scientist and you have a letter from an official of the Church

advising that you are a practicing member of the Church.

Please detail your child’s immunizations to date in the table below. The College will review these details on a regular basis to ensure our records are up to date. Where your child is in the Nursery Room please keep these records updated as your child’s immunizations are carried out.

The National Immunization Program Valid From July 2007

Please provide a copy of your child’s immunisation statement

Please note:

Hepatitis B vaccine should be given to all infants at birth and should not be delayed beyond 7 days.Wherever possible, the same brand of DTPa should be used at 2, 4 and 6 months.

You will need to provide a copy of your child’s immunization schedule upon enrolment.

Copy of Immunization Book on File (College use only): Yes No

VI

CHILD’S HEALTH DETAILS

Does your Child have any of the following: Allergies Yes No Food Allergies Yes No

Medical Conditions Yes No History of Ilnesses or Injuries Yes No Precribed Medications Yes No If you answer yes to any of the questions below you must provide Risk Mininisation Plans or Medical Action Plans by a GP.

Allergies to Food: (please specify which foods and the signs/symptoms to be aware of, if any): ……………………………………………………………………………………………………………………………………………………………………….……………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………

Other Allergies (please detail and specify the signs/symptoms to be aware of, if any): …………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………

Does your child require medication for allergies? Yes No (please give details)

…………………………………………………………………………………………………………………………………………………………………

Does your child have a history of illnesses or injuries? Yes No (please give details)

………………………………………………………………………………………………………………………………………………………………

Does your child have any current medical conditions? Yes No (please give details)

…………………………………………………………………………………………………………………………………………………………………

Is your child currently on any prescribed medications? Yes No (please give details)

…………………………………………………………………………………………………………………………………………………………………

VII

INFORMATION REQUIRED FOR CHILDREN UNDER THREE YEARS OF AGE

Please tick where appropriate and provide comments where necessary.

Eating Routines

Feeds Self ………………………………………………………………………………………………………………………………………

Uses spoon or utensils ……………………………………………………………………………………………………………………

Uses cup …………………………………………………………………………………………………………………………………………

Uses bottle ……………………………………………………………………………………………………………………………………

Toileting Routines

Nappies ……………………………………………………………………………………………………………………………………

Being toilet trained ………………………………………………………………………………………………………………………

Toilet Trained ………………………………………………………………………………………………………………………………

Toileting Routines

Nappies ………………………………………………………………………………………………………………………………………

Being toilet trained ………………………………………………………………………………………………………………………

Toilet trained …………………………………………………………………………………………………………………………………

Sleeping Routines

Sleeps in cot ………………………………………………………………………………………………………………………………

Sleeps in bed with safety guard ……………………………………………………………………………………………………

Sleeps in bed without safety guard …………………………………………………………………………………………………

ADDITIONAL INFORMATION ABOUT YOUR CHILD

The following information pages will be shared with your child’s caregivers. Confidential copies will be kept with your child’s developmental profile in their room as well as on the main file for office use.

Usual time awake: …………………………………………………………. Usual evening bedtime: ……………………………………

Daytime sleep (approximate time of day and length): ………………………………………………………………………………

What does your child take to bed? ………………………………………………………………………………………………………………

Any special bedtime routines while at home: (ways in which they are put to bed or positions they like to lie in):

…………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………

VIIIAre there any foods your child particularly likes? ………………………………………………………………………………………

Does your child have any fears? (E.g. noise, animals): ………………………………………………….……………………………

Does your child get upset when left with other people? ….………………………………………..…………………………………

Does your child have any disabilities or special needs (please detail):

………………….………………………………………………………………………………..……………………………………………………………

…………………………………………………………………………………………………………………………………………………………………

Are there any words that we may need to know that have special meaning to your child (translate where necessary):

…………………………………………………………………………………………………………………………………………………………………

Has your child been in care before (at another Service or at home with family) Yes No (please give details) ………………….………………………………………………………………………………..……………………………………………………………

…………………………………………………………………………………………………………………………………………………………………

What do you love about your child that you would like to share with us?

………………….………………………………………………………………………………..………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………

How can we assist your child this year? What would you most want for your child at our College? Are there any particular areas of concern that you feel we need to know about?

………………….………………………………………………………………………………..………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………

What information do you consider important for you to know each day and what is the best means of communicating this with you? ………………………………………………………………………………………………………………………………..……………………………………

………………….………………………………………………………………………………..………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………

Is there any further information which you feel may assist us in providing the service best suited to your needs and the needs of your child? (E.g. recent significant events, family situation, religious beliefs etc.):

………………….………………………………………………………………………………..………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………

Are there any skills or specials talents that you or family members have that you would like to contribute to the College’s program? …………………………………………………………………………………………………………………………………………………

………………….………………………………………………………………………………..………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………

IX

Enrolment Fee

A non---refundable fee of $150 is required to process your enrolment.

Please fill out your information below.

Parent’s surname: ……………………………………………………………..… Name: ……………………………………………

Address: …………………………………………………………………………………………………………………………………….…

Phone number: ………………………………………………………… Mobile: ………………………………………………………

Payment type: Credit Card, Direct Deposit or Cheque made payable to Adam & Noah Early Learning College:

Credit card*

I authorise Adam & Noah Early Learning College to deduct $150 non---refundable enrolment fee from my allocated credit card below.

Name on credit card: ………………………………………………………………………………………………………………………

Credit card number: ………………………………………………………………………………………………………………………….

Valid from ntil : ………........………. CCV: …………………… (3 digits on the back of the card)

Signed: ………………………………………………………………………………………………………..... Date: ………………………

Adam and Noah Early Learning College Direct Deposit

Bank Name: WestpacBSB: 034- 069Account: 089635Ref: Family Name\Childs NameBank Account Name: Adam and Noah PTY/LTD

XPERMISSIONS AND AGREEMENTS TO TERMS

The below section outlines various policies and procedures followed by the College. Please ensure you read over these care-fully and tick each item to indicate understanding and then sign the last page approving permission for these to occur.

Child’s Name: Date of Birth:

Emergency or Accidents Yes No

In the event of an emergency, illness or accident (when the College is unable to contact the Parent / Guardian or the Authorised Contact/s), I / We give the College Team Member consent to provide Medical or Hospital atten-tion for our child. I / We agree to pay any expenses incurred for Medical treatment and Transport. I/we authorise all staff/employees of Adam and Noah Early learning College (to accompany our child/ren outside the education and care service premise) in the event of an emergency or accident where such treatment is needed.

Administering of Paracetamol Yes No I / We agree for a College Team Member to administer ONE dosage of Paracetamol in the event of our child’s body temperature rising above 37.5°C. I / We understand that the Team Member will make contact with the Par-ents / Guardians or the Emergency Contacts to inform us that Paracetamol is being administered and discuss at the time further actions to take in the event that the temperature does not subside within an appropriate time frame.

Permission for Photography Yes No

I / We hereby give consent for our child to be photographed/ video taped at the College, their name and age to be used for the room programming, College displays and/or publications (e.g. Newsletters). Where this information may be utilized outside of the College, further permission will be sought.

Permission for Observation Yes No

I / We give permission for our child to be observed for Team Member, student or visitor purposes. Students and visitors will be from accredited training programs and will work in conjunction with your child’s caregivers. If questioning or testing is to be carried out I / we will be asked for further permission.

Payment of Fees and Enrolment Fee Yes No

I / We agree to maintain our fees two weeks in advance as per the College’s fee policy. We will ensure our fees are kept up to date by making payments on the required day via Westpac Payway or as agreed with the College.I / We are aware that failure to pay due fees causing our account to fall behind by more than one week may jeopardise our childs place at the College. I/we agree that should our fees become overdue a fee of $30.00 could be imposed on our account

I / We agree to pay an enrolment fee prior to start date, which is $150 per child.

Westpac Payway Transactions Yes No Where an Westpac (direct debit) arrangement has been entered into, I/we authorize the College to make with-drawals from my/our nominated account as specified in the Direct Debit Request Form, as determined by the College. In accordance with the terms and conditions herein and in any subsequent agreement with the College I/we acknowledge that such withdrawals may include amounts representing any arrears that are owed by me/us. I / We understand that any costs incurred by the College in collecting any arrears owed may be charged to my/our account. I/We agree should our payway payment decline a dishonour fee of $150.00 could be imposed on our account. I/We agree should our payway payment decline a dishonour fee of $150.00 could be imposed on our account.

Permission for Evacuations Yes No I / We hereby give permission for our child to participate in regular evacuation drills. I / We understand that our child will be relocated from the College under the supervision of their caregivers and a College Team Member to a safety zone for evacuation purposes. Please refer to the College’s Evacuation Plans and Procedures for information.

Sunscreen Application Yes No I / We agree for the College Team Member to apply 30+ SPF sunscreen regularly to our child for outdoor play purposes. I / We understand that the College may use a variety of sunscreen brands from time to time, and this information will be advised to us on Parent Communication Boards in the College foyer and rooms. If my child requires special sunscreen I/we agree to supply this product to the College.

XIInsect Repellant Applications Yes No

I / We agree for a College Team Member to apply Insect Repellant to our child where necessary for indoor or outdoor purposes. I / We understand that the College may use a variety of insect repellant brands from time to time, and this information will be advised to us on Parent Communication Boards in the College foyer and rooms. If my child requires special repellant I/we agree to supply this product to the College.

Bottle Permission Yes No I / We understand that if our child requires a bottle on his/her bed to transition to rest time, as the parent I take full responsibility understanding that this is an individual requirement for my child. I / We also understand that Team members will not give my child the bottle, but they will be supervised at all times when having their bottle and the bottle will be removed and placed away when the child has finished and drifted off to sleep.

Child Care Subsidy Yes No I / We understand that it is our responsibility to notify the College of our Customer Reference Numbers (CRNs) even where our family will not be claiming Child Care Subsidy as reduced fees on a weekly basis.

Parent Handbook Yes No I / We acknowledge that we have received and read the College’s Parent Handbook. I / We understand any changes to this Handbook will be displayed on the Parent Communication Boards in the College foyer and rooms.

Security Yes No I / We acknowledge that the College has a state of the art security system in place and as such my child may be filmed at various times throughout the day via the Closed Circuit Television (CCTV). I acknowledge that at no time will this footage be made public without prior permission.

College Policies and Procedures Yes No I / We acknowledge that the College Policies and Procedures are available in the foyer at all times to view. I / We understand that any changes to these policies will be carried out where appropriate in consultation with us as Parents / Guardians and any changes to these policies will be displayed on the Parent Communication Boards in the College foyer.

Cancellation of Care Yes No I / We understand that three week’s written notification is required in advance when cancelling care and all fees must be paid in full on completion.

Fees for Public Holidays and Absent Days Yes No I / We understand that Public Holidays, Absent Days and Pupil Free Days are charged at the normal daily fee rate and that complimentary make---up days will not be available.

Enrolment Fee Yes No I / We understand that a $150 non---refundable enrolment fee is required to be sent in with this form before Enrolment can take place.

Late Fees Yes No I / We understand that late fees will be charged if our child is not collected by the advertised closing time, and that no Child Care Subsidy can be claimed for this fee. Late fees charged are as follows: $1 per minute for each minute that your child has not been collected after closing time.

Priority of Access Yes No I / We understand that if our family falls under Priority Access we may be required to alter our days or give up our place in the College in order to provide a place for a higher Priority family according to the following Priority Access Guidelines:

First Priority – children at risk or serious abuse or neglect;Second Priority – children whose Parents satisfy the work, training and study guidelines specified by the Government; andThird Priority – all other children.

Infectious Diseases / Clearance Certificates Yes No I / We understand that our child will be excluded from the College if they contract a contagious disease or condition. I / We understand that our child will not be accepted back into the College until a ‘clearance certificate’ is issued from a Medical Practitioner. Please refer to our Policies and Procedures for further information.

Fun Spaceship Yes No I/we give permission for our child to attend the fun spaceship throughout the year and understand that a new permission will be required to be signed annually. I understand that the Fun Spaceship is located on the College grounds and that the children will be walking there as a group from their classroom.

XII

Academic Yes No I/we give permission for our child to participate in the academic program which will be held in various areas of the college including classrooms, auditorium, and the playground areas and understand that a new permission will need to be completed for this annually. I/we also giver permission for our child to walk to these areas for the program as a group from their classroom when required.

Auditorium and Fun Spaceship Indoor Playground Yes No I/we giver permission for our child to attend the HP Entertainment Centre and Fun Spaceship Playground for various activities throughout the year. I understand that this is located on college grounds and that the children will be walking there as a group from their classroom. I also understand that a new permission will need to be completed for this activity annually.

Library Yes NoI/we giver permission for our child to attend the Logan West Library located at 69 Grand Plaza Drive, Browns Plains QLD 4118 on their designated days. I understand that the children will be travelling using the college bus with a fully licensed and qualified driver and that the classroom educators will also be attending this excursion. I also understand that we will need to provide our child’s car seat for these trips and that a new permission will need to be signed for this annually.

Non – Immunisation Yes No I / We understand that if our child is NOT immunized in accordance to the Government requirements (refer to our immunisat ion details page) our child will be excluded from the College until the infectious period of the disease or condition has passed. (Please refer to our Policies and Procedures for further information).

Privacy Statement Yes No Yes No By enrolling in the College I /we are entering into an agreement for with the College and have received a copy of the College’s Privacy Statement. I / We have read and understood the Privacy Statement and agree to the use of confidential information as stated in the Privacy Statement.By signing this form I/we declare and confirm:

I / We are lawfully authorised in relation to the Child referred to in this Enrolment Form;All information provided in this Enrolment Form is true and correct; and

I/we have read, fully understand and agree to comply with all of the policies and procedures detailed in this Enrolment Form including items 1 to 23 above, and any other policies and procedures advised by the College either directly or by making them available for perusal at the College.

Signature of Primary Parent/Guardian: Date:

Signature of Secondary Parent/Guardian: Date:

CWA - Child Care Written Agreement TO BE SIGNEDAs part of the new Child Care Subsidy (CCS) it is a regulation requirement that all Services, Parents and/or Guardians completeand sign a Complying Written Arrangement (CWA) in accordance with the Family Assistance Administration Act. CCS paymentsare not paid until the CWA form has been signed and submitted. Once the CWA form and enrolment details have beencompleted and received by the department parents will be notified and required to accept their child’s enrolment at the centre.

ANELC Music Club

MUSIC CLUBAdam & Noah Early Learning College

Tuition Form

$15 per LessonUp to 3 lessons per weekFour InstrumentsLearn to read music

Join the Music Program•Piano•Electric Drums•African Drums•Guitar

Child’s Name __________________________________________

Classroom __________________________________________

Number of lessons per week 1 2 3

Booked Days at College Monday Tuesday Wednesday Thursday Friday

Joel Vanderpuije

Drums Guitar Piano

Signature____________________________

Date ____/____/____

Adam & Noah Music Club [email protected] 07 3054 1054

African Drums

ADAM AND NOAH PTY LTD (407130)

Direct Debit Request (DDR)You may contact us as follows:-

All communication addressed to us should include your Customer Number.

Phone: 0730541054Email: [email protected]: 130-138 Waller Rd

HERITAGE PARK, QLD, Australia 4118

PART A - Your DetailsCustomer Number:

Customer Name:

Phone Number:

Email Address:

Address:

State: Postcode:

PART B - SchedulePayments will be debited on the due date.

PART C - Payment AmountsPayments amount will be debited in full.

Surcharges apply: Visa/Mastercard 1.5%, Bank Account AUD 1.00

Page 1 of 5

PART D - Cheque/Savings Accountor Credit Card Authorisation! I/We request and authorise ADAM AND NOAH PTY LTD (407130) to arrange, through its ownfinancial institution, a debit to your nominated account any amount ADAM AND NOAH PTY LTD(407130), has deemed payable by you. This debit or charge will be made through the BulkElectronic Clearing System (BECS) from your account held at the financial institution you havenominated below and will be subject to the terms and conditions of the Direct Debit RequestService Agreement.

Financial Institution:

Branch:

Account Name:

BSB No. -

Account Number:

I/We request and authorise Acknowledement. By signing and/or providing us with a valid instructionin respect to your Direct Debit Request, you have understood and agreed to the terms andconditions governing the debit arrangements between you and ADAM AND NOAH PTY LTD as setout in this Request and in your Direct Debit Request Service Agreement.

Signature: Date:

Signature: Date:

If debiting from a joint bank account, both signatures are required.

OR

! I request you ADAM AND NOAH PTY LTD to arrange for funds to be debited from my nominatedcredit card according to the schedule specified above and attached Direct Debit ServiceAgreement.

Credit Card Number:

Expiry Date: M M / Y Y

Cardholder Name:

Signature: Date:

Completed ApplicationReturn your completed application by mail to:-

Mail: 130-138 Waller RdHERITAGE PARK, QLD, Australia 4118

Page 2 of 5

Customer Direct Debit Request (DDR) Service AgreementThis is your Direct Debit Service Agreement with ADAM AND NOAH PTY LTD (407130) 56 157 881626. It explains what your obligations are when undertaking a Direct Debit arrangement with us. Italso details what our obligations are to you as your Direct Debit provider.

Please keep this agreement for future reference. It forms part of the terms and conditions of yourDirect Debit Request (DDR) and should be read in conjunction with your DDR authorisation.

Enquiries

You can contact us directly or alternatively contact your financial institution. These should be madeat least 7 working days prior to the next scheduled drawing date. You may contact us as follows:-

All communication addressed to us should include your Customer Number.

account means the account held at your financial institution from which we are authorised toarrange for funds to be debited.

agreement means this Direct Debit Request Service Agreement between you and us.

banking day means a day other than a Saturday or a Sunday or a public holiday listed throughoutAustralia.

debit day means the day that payment by you to us is due.

debit payment means a particular transaction where a debit is made.

direct debit request means the Direct Debit Request between us and you.

us or we means ADAM AND NOAH PTY LTD (407130) you have authorised by requesting a DirectDebit Request.

you means the customer who has signed or authorised by other means the Direct Debit Request.

your financial institution means the financial institution nominated by you on the DDR at which theaccount is maintained.

How to Contact Us

Phone: 0730541054

Email: [email protected]

Mail: 130-138 Waller RdHERITAGE PARK, QLD, Australia 4118

Definitions

Page 3 of 5

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By signing a Direct Debit Request or by providing us with a valid instruction, you have authorised usto arrange for funds to be debited from your account. You should refer to the Direct Debit Requestand this agreement for the terms of the arrangement between us and you.

We will only arrange for funds to be debited from your account as authorised in the Direct DebitRequest.

or

We will only arrange for funds to be debited from your account if we have sent to the addressnominated by you in the Direct Debit Request, a billing advice which specifies the amount payableby you to us and when it is due.

If the debit day falls on a day that is not a banking day, we may direct your financial institution todebit your account on the following banking day. If you are unsure about which day your accounthas or will be debited you should ask your financial institution.

We may vary any details of this agreement or a Direct Debit Request at any time by giving you atleast fourteen (14) days written notice.

You may change, stop or defer a debit payment, or terminate this agreement by providing us with at least 7 days notification by writing to:130-138 Waller RdHERITAGE PARK, QLD, Australia 4118orby telephoning us on 07 30541054 during business hours;orarranging it through your financial institution, which is required to act promptly on your instructions.

It is your responsibility to ensure that there are sufficient clear funds available in your account toallow a debit payment to be made in accordance with the Direct Debit Request.

If there are insufficient clear funds in your account to meet a debit payment:

you may be charged a fee and/or interest by your financial institution;

you may also incur fees or charges imposed or incurred by us; and

you must arrange for the debit payment to be made by another method or arrange for sufficientclear funds to be in your account by an agreed time so that we can process the debit payment.

You should check your account statement to verify that the amounts debited from your account arecorrect.

Debiting your account

Amendments by us

Amendments by you

Your obligations

Page 4 of 5

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If you believe that there has been an error in debiting your account, you should notify us directly on0730541054 and confirm that notice in writing with us as soon as possible so that we can resolveyour query more quickly. Alternatively you can take it up directly with your financial institution.

If we conclude as a result of our investigations that your account has been incorrectly debited we willrespond to your query by arranging for your financial institution to adjust your account (includinginterest and charges) accordingly. We will also notify you in writing of the amount by which youraccount has been adjusted.

If we conclude as a result of our investigations that your account has not been incorrectly debited wewill respond to your query by providing you with reasons and any evidence for this finding in writing.

You should check:

with your financial institution whether direct debiting is available from your account as directdebiting is not available on all accounts offered by financial institutions.

your account details which you have provided to us are correct by checking them against arecent account statement; and

with your financial institution before completing the Direct Debit Request if you have anyqueries about how to complete the Direct Debit Request.

We will keep any information (including your account details) in your Direct Debit Requestconfidential. We will make reasonable efforts to keep any such information that we have about yousecure and to ensure that any of our employees or agents who have access to information aboutyou do not make any unauthorised use, modification, reproduction or disclosure of that information.

We will only disclose information that we have about you:

to the extent specifically required by law; or

for the purposes of this agreement (including disclosing information in connection with anyquery or claim).

If you wish to notify us in writing about anything relating to this agreement, you should write to

ADAM AND NOAH PTY LTD130-138 Waller RdHERITAGE PARK, QLD, Australia 4118

We will notify you by sending a notice in the ordinary post to the address you have given us in theDirect Debit Request.

Any notice will be deemed to have been received on the third banking day after posting.

Dispute

Accounts

Confidentiality

Notice

Page 5 of 5

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XV

Adam & Noah Early Learning College (07) 3054 1054

OFFICE USE ONLY

Enrolment details entered: Yes No -----/-----/-----/

Individual photographs of child and any

authorised contacts: Yes No -----/-----/-----/

Photographs for door access: parents/carer Yes No -----/-----/-----/

Westpac PayWay Authority signed: Yes No -----/-----/-----/

Enrolment fee paid: Yes No -----/-----/-----/

2 weeks in advance payment: Yes No -----/-----/-----/

Parent orientation carried out: Yes No -----/-----/-----/

Excursion/ Incursion forms signed: Yes No -----/-----/-----/

Copy of Medicare Card: Yes No -----/-----/-----/

Copy of Health Care Card: Yes No -----/-----/-----/

Copy of Drivers License: Yes No -----/-----/-----/

Allergies & ilness info provided: Yes No -----/-----/-----/

Immunisation schedul provided: Yes No -----/-----/-----/

Uniform set & water bottle recieved: Yes No -----/-----/-----/

Profile folder organised: Yes No -----/-----/-----/

Entered on database: Yes No -----/-----/-----/

Pocket tag created: Yes No -----/-----/-----/

!

!

Welcome to Adam and Noah Early Learning College

Things to remember before your first day

You need to log onto https://my.gov au/ and activate your child for CCS. Full fees will apply until this process is complete . You are welcome to come in have some 'play dates' in your classroom before you start. You will need to have all required documentation submitted to reception. Including any medical action plans, court orders etc. Please remember to read our parent handbook along with the centre policies and procedures. If you have any questions regarding this please contact reception . Most importantly remember our team is here to provide the highest quality care for your child, family input is a large part of this and we would love to have your input.

The first week

What to bring: Sheet set (cot size), water bottle, hat, dummy and milk bottle if required. Please remember to label everything they bring. What to expect: Your child will more than likely be emotional on the first few drop offs. To ease this stress, it helps to have positive conversations around joining kindy & meeting their new friends. Remember to say good-bye and reinforce your child that you will be back for pickup. Please call if you are feeling restless and concerned. Remember we will call you if they don't settle. We recommend checking out the following site for some more helpful information. http://raisingchtldren.net.au You will start to develop a relationship with the educators. Please share your thoughts and intentions for your child's care. You will receive an email to join My Family Lounge. This is where you can view all you child's documentation and photos. If you require any assistance with this please see reception.

For the first month

Your child will begin to build new relationships and form a strong sense of identity. This does happen in different time frames depending on the individual. Children will often get sick a little more often in care in the first few weeks as their immunity builds. Some helpful information can be found on our family board regarding health and immunisation. https://www.health.qld.gov .au, http://www.healthychild.org You will have a strong sense of who your educators are and how they work with your child. Being open and honest with your expectations will help us provide the best outcomes for your child.

For the first year

Your child will know all our staff and feel like a part of our family. They would have developed a strong bond with their direct educators and sometimes even cry when you pick them up because they don't want to go home. This is not because they don't miss you, but because they have had a great day and do not want to stop playing. You will know our team and have formed strong relationships.

Thank you for choosing to join our community here at Adam and Noah.

enrolment form - adam & noah early learning...

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