Enrolment Form | Miri’s Kindy

Child's Details

Child's date of birth:

Is there anyone who is prohibited from having contact with or collecting the child?
YesNo

If Yes, please provide details:

Are there any court orders, parenting orders, or parenting plans relating to powers, duties, responsibilities, or authorities of any person in relation to the child or access to the child?
YesNo

If Yes, please email any court orders to info@miriskindy.com.au

Are there any details of any other court orders relating to the child’s residence or the child’s contact with a parent or other person?
YesNo

If Yes, please email details of other court orders to info@miriskindy.com.au

Days required:
MonTueWedThuFri

Start date required:

Parent/Guardian Details

Parent/Guardian 1

Date of birth:

Parent/Guardian 2

Date of birth:

Immunisation and Birth Certificate

Please supply the following documents before your child’s first day of attendance.

Immunisation History Statement:
A copy of your child’s current Immunisation History Statement is required.
This can be accessed through your Medicare MyGov account. No other form is acceptable.
Please email document to info@miriskindy.com.au

This is a regulatory requirement and must be provided prior to your child’s first day.

Birth Certificate

A copy of your child’s birth certificate is also required. Either email document to info@miriskindy.com.au or bring a hard copy to the centre.

Health Information

Does your child have a specific health care need or medical condition?
YesNo

Does your child have an additional need (e.g., developmental, physical, behavioural)?
YesNo

Does your child have any allergies?
YesNo

Does your child have any dietary restrictions or preferences?
YesNo

Has your child been diagnosed as at risk of anaphylaxis?
YesNo

Has your child been diagnosed with asthma?
YesNo

Do you have a medical management plan (e.g., asthma, anaphylaxis) provided by your doctor?
YesNo

If yes, either email document to info@miriskindy.com.au or bring a hard copy to the centre.
This will be followed up by the completion of a medical conditions and risk management plan with the centre’s Nominated Supervisor.

Is there any other information you wish us to know about your child?
YesNo

Emergency and Authorised Contact Details

Doctor

Release child to Doctor if required?
YesNo

Dentist

Release child to Dentist if required?
YesNo

Please list at least two people authorised to collect the child and/or be contacted in an emergency if parents/guardians are unreachable. You may use the same people for both roles:

Person 1

Emergency Contact?
YesNo

Authorised for daily pick up?
YesNo

Person 2

Emergency Contact?
YesNo

Authorised for daily pick up?
YesNo

Person 3

Emergency Contact?
YesNo

Authorised for daily pick up?
YesNo

Additional Authorisations
Is any person authorised to consent to medical treatment or administration of medication for the child?:

YesNo

YesNo

Is any person authorised to allow educators to take the child outside the service premises?

YesNo

YesNo

Is any person authorised to arrange or consent to transportation of the child?

YesNo

YesNo

Medical Consent Declaration

In the event of an emergency, illness, or accident concerning my child and the educators being unable to contact me or any other authorised person, I give consent for the approved provider, nominated supervisor, or educator to:

• Seek medical treatment for my child from a registered medical practitioner, dentist, hospital, or ambulance service.

• Arrange transportation of my child by ambulance service if required.

YesNo

Parking Agreement

I have read and understood all parking requirements, limitations, and restrictions. I agree to park only in legal parking areas and bays as permitted by the RTA and local council regulations:

YesNo