Authority to collect

Enrol Your Child

Enrolment Form

Form for new enrolments to the centre

Step 1 of 9

Child's Name*
First Name Family Name Other
Known As*
Gender*
Primary Language*
Date of Birth*
Birth Certificate Cited*
CRN*
Address*
Street Address Address Line 2 City State Postcode
Indigenous Status
Aboriginal*
Torres Strait Islander*

Eligible Parent/Guardian & Billing Details
Name*
First Name Family Name
Date of Birth*
CRN*
Relationship to Child*
Contact Priority*
Please enter a number from 0 to 5.
Primary Language*
Home Address*
Street Address Address Line 2 City State Postcode
Work Address*
Street Address Address Line 2 City State Postcode
Home Phone*
Work Phone*
Mobile Phone*

Other Parent/Guardian If Applicable
Name*
First Name Family Name
Date of Birth*
CRN*
Relationship to Child*
Contact Priority*
Please enter a number from 0 to 5.
Primary Language*
Home Address*
Street Address Address Line 2 City State Postcode
Work Address*
Street Address Address Line 2 City State Postcode
Home Phone*
Work Phone*
Mobile Phone*

Collection Authorities Only
Name*
First Name Family Name
Relationship to Child*
Home Address*
Street Address Address Line 2 City State Postcode
Home Phone*
Work Phone*
Mobile Phone*
Section Break
Name*
First Name Family Name
Relationship to Child*
Home Address*
Street Address Address Line 2 City State Postcode
Home Phone*
Work Phone*
Mobile Phone*
The people nominated have been given approval ONLY to collect the child and should NOT be contacted in an emergency.

Annual Parent Information

Parent Information Annual Update

Annual information for our records to ensure everything is up to date

LinkedIn
This field is for validation purposes and should be left unchanged.
Your Child's Information
Children at RPCC*
How many children do you have at RPCC
Child #1
Name | Child #1*
First Middle Last
The name of your first child at RPCC
Date of Birth | Child #1*

Their first child's birthday
Child #2
Name | Child #2*
First Middle Last
The name of your second child at RPCC
Date of Birth | Child #2*

Their second child's birthday
Child #3
Name | Child #3
First Middle Last
The name of your third child at RPCC
Date of Birth | Child #3*

Their third child's birthday
Child #4
Name | Child #4*
First Middle Last
The name of your fourth child at RPCC
Date of Birth | Child #4*

Their fourth child's birthday
Parent/Guardian Details
Parent/Guardian #1*
Parent/guardian one's name
Relationship to child*
Relationship to child details*
Phone number*
Enter the best number to reach you on
Email

Enter your email address
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter parent/guardian #1's address
Parent/Guardian #2*
Parent/guardian two's name
Relationship to child*
Relationship to child details*
Phone number*
Enter the best number to reach you on
Email

Enter your email address
Address (if different to guardian #1)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter parent/guardian #2's address
Emergency Contact Details
Emergency Contact #1*
First Last
Enter the name of your first emergency contact
Relationship to child*
Telephone #1*
Optional | Telephone #2
Emergency Contact #2*
First Last
Enter the name of your second emergency contact
Relationship to child*
Telephone #1*
Optional | Telephone #2
Add another emergency contact?*
- Yes
- No
Emergency Contact #3*
First Last
Relationship to child*
Telephone #1*
Optional | Telephone #2
Add another emergency contact*
- Yes
- No
Emergency Contact #4*
First Last
Relationship to child*
Telephone #1*
Telephone #2
Your child's health
IS YOUR CHILD IMMUNISATION UP TO DATE?*
- YES
- NO
Signed*
ENTER YOUR NAME TO CONFIRM THAT THE DETAILS ABOVE ARE CORRECT. OR PLEASE BRING IN YOUR BLUE BOOK FOR US TO PHOTOCOPY.
HAVE THERE BEEN ANY NEW ALLERGIES OR HEALTH CONCERNS THAT WE NEED TO KNOW ABOUT?*
- Yes
- No
PLEASE CONTACT US STRAIGHT AWAY IF THERE ARE.

Rose Park Community Childcare

Enrolment Form

Step 1 of 9

Eligible Parent/Guardian & Billing Details

Other Parent/Guardian If Applicable

Emergency Contacts and Collection Authorities

Section Break

Collection Authorities Only

Section Break

Booking Preferences

UNIVERSAL ACCESS DATA COLLECTION

Parent Information Annual Update

Your Child's Information

Child #1

Child #2

Child #3

Child #4

Parent/Guardian Details

Emergency Contact Details

Your child's health