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Lilybelle Early Education Centre Enrolment Form

269a New Line Rd Dural NSW 2158
02 8443 0286 | steph.gomes@lilybelle.net.au

Child's Details Education and Care Services National Regulations - Regulation 160 (3a, e)

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Session End Time

Primary Parent/Carer Education and Care Services National Regulations - Regulation 160 (3b)


(Primary Parent must also be the registered CRN number holder)

Secondary Parent/Carer Education and Care Services National Regulations - Regulation 160 (3b)


Cultural Consideration Education and Care Services National Regulations - Regulation 160 (f, g, h)

Medical Information Education and Care Services National Regulations - Regulation 160 (3a, I, j)

If yes, please provide a medical management plan, which the child's medical practitioner has prepared. The Plan should include:
  • A photo of the child
  • If relevant, state what triggers the medical condition, allergy or anaphylaxis
  • First aid needed
  • Contact details of the doctor who signed the plan
  • When the Plan should be reviewed
Note: This can be uploaded at the end of this form.
(If yes, please attach relevant details.)
Note: This can be uploaded at the end of this form.
Medication will only be administered if it is in the original container with the original label and instructions that can be clearly read and before the expiry or use by date. Additionally, if the medication has been prescribed by a medical practitioner:
  • The label must contain the child's name and
  • Parents must provide any verbal or written instructions provided by the medical practitioner.
Education and Care Services National Regulations Regulation 95
Any medication, including non-prescription medication like nappy creams and paracetamol, must be authorised by parents or an authorised nominee on our “Administration of Authorised Medication” form. Education and Care Services National Regulations Regulation 93

Immunisation Details


Please note: Approved documentation must be provided before your child can attend. See Immunisation Policy
Note: This can be uploaded at the end of this form.

Please provide a copy of your child's: Immunisation History Statement provided by Medicare
Note: This can be uploaded at the end of this form.

Parent Initials

Parent Initials

Developmental Information

Is your child undertaking or have undergone assessment to support any particular developmental areas such as speech therapy, occupational therapy, Autism spectrum disorder? Please attach supporting documents Please provide us with any other information we should know about your child

(For example, additional learning and support needs, information about the child’s wellbeing, physical comfort or personal needs, favourite activities, fears, special words (please translate if applicable), toileting and sleeping practices etc.)

Family Information

Child's Routine

Court Order Education and Care Services National Regulations - Regulation 160 (3c, d)

If yes, please provide all relevant documentation and paperwork
If yes, please provide all relevant documentation and paperwork

Please note that without this documentation we cannot legally enforce the Order/s.

First Emergency Contact Education and Care Services National Regulations - Regulation 160 (3b, ii, iii, iv, v) 161 (1a, I, ii, 1b)

There may be times or situations where your child has had an accident, injury, trauma or illness and Parent/s cannot be reached or are unable to collect their child. To deal with these circumstances and in case of an emergency the Service will inform the following person to collect and care for the child. This person must live a maximum of 30 minutes from the Service and must provide identification when collecting the child.

Please obtain the person's consent before listing them as an emergency contact

Second Emergency Contact Education and Care Services National Regulations - Regulation 160 (3b, ii, iii, iv, v) 161 (1a, I, ii, 1b)

Please obtain the person's consent before listing them as an emergency contact

Child Care Subsidy (CCS)

Child Care Subsidy will be paid directly to the Service to reduce the fees families pay. To claim Child Care Subsidy (CCS) Families must meet eligibility requirements which include:

Please Note: If you need assistance with filling out this form please speak to the Director who will be happy to help. Please ensure that if any details change, you notify the Service immediately.

Enrolment Agreement

PLEASE READ THE FOLLOWING AGREEMENT CAREFULLY BEFORE SIGNING. PLEASE ASK IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU ARE UNSURE OF

Please tick the following items to authorise:

HEALTH & SAFETY:
PHOTOGRAPHY & VIDEO:

Attached Documents

Please ensure ALL RELEVANT documents are attached to this application before submission. (Only valid file types are allowed - jpg, png, pdf)

How did you hear about us?

Confirmation & Signature

Privacy Disclaimer

We acknowledge and respect the privacy of its clients. The enrolment information that is collected assists us to meet our legislative obligations and to provide the best level of education and care for your child. By completing this form, you have consented to this information being collected. The information will be used by educators/staff members and relevant government authorities. You have the right to access and alter personal information concerning yourself or your child in accordance with the Privacy Act 1988 and our Privacy and Confidentiality Policy.