Printed from ChabadHouse.org.au

Enrolment Form

  • DATES

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

  • Early Drop-off / Late Pick-up

    Please select below if you would like early drop-off, or late pick-up for an additional $5 each. 

  • $0.00
  • CHILD INFORMATION

    Please fill-in a separate form for each child.

  • PARENTS/GUARDIAN INFORMATION

    Primary parent or guardian (as recorded with Centrelink)

  • DETAILS FOR CCS

    This information must be complete in order to receive CCS (Child Care Subsidy).

  • 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 1

  • MEDICAL CONTACTS

    Please enter your child's Doctors information.
  • AUTHRISATION 

  • MEDICAL CONDITION AND/OR DIETARY RESTRICTION 

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

  • IMMUNISATIONS 

    In order to qualify for CCS, we needs to sight the child's immunisation history statement.  Please email chanie@chabadhouse.org.au with your child’s Medicare immunisation form.

  • ADDITIONAL INFORMATION

  • CCS ENROLMENT AGREEMENT

    As a part of your enrolment at our service (Camp Gan Izzy) 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 North Shore against responsibility for any accident, loss or injury suffered by my child/ren during the course of the activities.

    ·  I expressly release Chabad North Shore, its employees or officers from any claim or liability arising directly or indirectly from the enrolled program.

    ·  I agree to the terms and conditions listed here .

    ·  I understand 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 INFORMATION

    Please note: All bookings are final and there are no refunds for cancellations. For more information please see terms and conditions.

    IMPORTANT NOTE RE: CCS (CHILD CARE SUBSIDY)

    All payment will be processed upon completion of the enrolment form.

    If you are a new applicant and have not yet confirmed CCS, we will charge you 50% upon completion of the form and will charge the balance on two weeks prior to commencement of the camp session (to give you time to apply for CCS).

    If you are approved for CCS at a later date, and the subsidy is paid to Camp Gan Izzy, you will be reimbursed the difference.

    Click here for the rates.

    Click here for more information about CCS.

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    Credit Card
  • The information below should only be completed if you selected Direct Debit.

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