Printed fromChabadHouse.org.au
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Enrolment Form

  • CHILD 1

  • PROGRAM

  • CHILD INFORMATION 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • AUTHORISATION

  • MEDICAL CONDITION & DIETARY RESTRICTION 

  • If yes, you MUST email a colour copy of your child’s Action Plan to [email protected] and ensure they bring their medication on each day.

  • ADDITIONAL INFORMATION

  • CHILD 2

  • PROGRAM

  • CHILD INFORMATION 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • AUTHORISATION

  • MEDICAL CONDITION & DIETARY RESTRICTION 

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

  • ADDITIONAL INFORMATION

  • CHILD 3

  • PROGRAM

  • CHILD INFORMATION 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • AUTHORISATION

  • MEDICAL CONDITION & DIETARY RESTRICTION 

  • If yes, you MUST email a colour copy of your child’s Action Plan to [email protected] and ensure they bring their medication on each day.

  • ADDITIONAL INFORMATION

  • PARENTS/GUARDIAN DETAILS

    PRIMARY PARENT/GUARDIAN

    (This person's details are used to claim government subsidy) 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • SECONDARY PARENT/GUARDIAN 

  • ADDITIONAL/EMERGENCY CONTACTS

    (Minimum 2 required)

    Please enter additional contacts for this enrolment. This may include emergency contacts when you are unavailable to be contacted in the case of an emergency. E.g for medical authorisations, to authorise staff to remove the child form the facility or for any other emergencies. This may also include authorised nominees who may drop off or pick up this child or authorise excursions.

  • ADDITIONAL/EMERGENCY CONTACT  1   

  • ADDITIONAL/EMERGENCY CONTACT 2 

  • MEDICAL CONTACTS 

    Please enter your child's Doctors information. You should enter medical contact here.  

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

    Please email [email protected] with your child’s Medicare Immunisation form.

  • 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.

    Chabad Hebrew School 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.

    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 - [email protected] to discuss.

  • DOCUMENTATION

    Please bring-in your original Ketubah (Jewish marriage certificate) and your child’s birth certificate. 

  • PAYMENT INFORMATION

    A deposit of $100 per child is taken within 2 days of confirmation of this enrolment. The money will go towards the next term's fees. Payment is charged based on the payment plans you choose below. If CCS has not been confirmed before than, you will be charged regular rates at the first billing cycle, and once CCS is confirmed, the balance will be credited to your account for future billing cycles.

    Click here for the class rates. 
    Click here for more information about CCS.

  • Credit Card
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