Printed from ChabadHouse.org.au

Enrolment Form

  • DATES

    Please choose the date/s that you would like your child to attend.

  • $0.00 AUD
  • CHILD INFORMATION 

    Seperate form required for each child. 

  • PARENTS/GUARDIAN DETAILS

    PRIMARY PARENT/GUARDIAN

  • CHILD CARE SUBSIDY (CCS) DETAILS 

    This information must be completed entirely to receive Cenrelink subsidies. 

  • SECONDARY PARENT/GUARDIAN 

  • ADDITIONAL/EMERGENCY CONTACTS 

    (Minimum 2 required)

    Please enter additional contacts for this child's enrolment. This may include emergency contacts when you are not available to be contacted or authorised nominees who may drop off or pick up this child. 

    ADDITIONAL/EMERGENCY CONTACT  1   

  • ADDITIONAL/EMERGENCY CONTACT 2 

  • MEDICAL CONTACTS 

    Please enter your child's Doctors information. 

  • AUTHORISATION 

  • MEDICAL CONDITION & DIETARY RESTRICTION 

  • If yes, you MUST email a colour copy of your child’s Action Plan to chanie@chabadhouse.org.au and ensure they bring their medication on each day.

  • IMMUNISATIONS 
    The service needs to sight the child's Immunisation history statement. 

    Please email chanie@chabadhouse.org.au with your child’s Medicare Immunisation form.

  • ADDITIONAL INFORMATION

  • Child Care Subsidy (CCS) Enrolment Agreement

    As a part of your enrolment at our service we require you to confirm acceptance of the following items in order to be eligible to receive Government funding if available. Acceptance of these items as well as some of the other information in the enrolment form can be used as a Complying Written Arrangement. Please read these items and confirm your acceptance of these items, by signing below.

    ·   I confirm that my details in this enrolment form as well as the details of the child I am enrolling are correct.

    ·   I confirm I have agreed to days of care with this service and understand the start and end times of the care provided.

    ·   I confirm that care may be provided on a casual or flexible basis where available at my service(s) at my request.

    ·  I confirm I understand the usual fees associated with the care of my child which may vary from time to time.

    Camp Gan Izzy Enrolment Agreement

    By signing below, I confirm,

    I indemnify Chabad House of the North Shore Limited (CHOTNS) against responsibility for any accident, loss or injury suffered by my child/ren during the course of the activities.

    I expressly release CHOTNS, its employees or officers from any claim or liability arising directly or indirectly from the enrolled program.

    I agree to all the terms and conditions listed here.

    That my child will be photographed and videoed for the purposes of recording the wonderful services we offer, and sharing this information with our parent-body, and for encouraging the attendance of others within our community. If you specifically do not want pictures of video clips of your child/ren shared, please contact Chanie Schapiro to discuss.

  • PAYMENT

    If no Centrelink information is submitted, the full amount will be processed upon submission. 

    For details about CCS, please contact Chanie Schapiro ( chanie@chabadhouse.org.au ). 

    REGISTERED FOR CCS 

    Once this form is submitted, we will send this information to Centrelink, following this families registered previously for CCS will have to 'confirm' this booking with Centrelink to recieve the subsidy (via my.gov.au ). 

    We will charge 20% upon submission of this form.

    The balance will be charged 48 hours after we have sumbitted your information to Centrelink.  This allows you time to confirm your booking (with Centrelink via my.gov.au ).

  •   
    Credit Card
    Please fill-in direct debit information below.
  • The information below should only be completed if you selected Direct Debit.

  • See top of page for errors, if this form does not submit.

  • Should be Empty:
Secure This page uses TLS encryption to keep your data secure.
 
What Our Parents Say!
MEGAN ROSETTENSTEIN

I wanted to take the time to say a very, very huge thank you to all of you for making Nadav have the most wonderful holidays.

You guys do the most amazing adventures with the children and even when you are just at Chabad you engage them in the most wonderful activities.

Nadav has come home very very happy each day of the holidays because of you guys.

Thank you.