Common use of Education in New Zealand Clause in Contracts

Education in New Zealand. The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, when if received, should be securely destroyed once verified. For Office Use Only Identity record copied for NSN (if required) Immunisation record copied and held with enrolment ID Securely Destroyed: / / Signature: Date of Entry: Date of Exit: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North Shore. Parents / Guardians Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Emergency Contacts (Adults who are permitted to pick up your child – other than the above) Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Custodial Statement Are there any custodial arrangements concerning your child? Yes No If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required): Name of person/s who CANNOT pick up your child: Name: Name: Name: Name: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North Shore. Child’s Doctor Name of Medical Centre: Name of Doctor: Phone: Child’s Health Early childhood services are required, as per the Health (Immunisation) Regulations 1995, to ask parents or guardians of a child to provide the Immunisation Record for each child attending their service and record the information from the Immunisation Record – or the fact that was not shown – on the Immunisation Register. Illness / Allergies: Is your child up-to-date with immunisations? (Please provide verification of all immunisations) Yes No For staff: Immunisation records sighted and details recorded Yes No Medicine

Education in New Zealand. The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, when if received, should be securely destroyed once verified. For Office Use Only Identity record copied for NSN (if required) Immunisation record copied and held with enrolment ID Securely Destroyed: / / Signature: Date of Entry: Date of Exit: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool Childcare North Shore. Parents / Guardians Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Emergency Contacts (Adults who are permitted to pick up your child – other than the above) Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Custodial Statement Are there any custodial arrangements concerning your child? Yes No If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required): Name of person/s who CANNOT pick up your child: Name: Name: Name: Name: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool Childcare North Shore. Child’s Doctor Name of Medical Centre: Name of Doctor: Phone: Child’s Health Early childhood services are required, as per the Health (Immunisation) Regulations 1995, to ask parents or guardians of a child to provide the Immunisation Record for each child attending their service and record the information from the Immunisation Record – or the fact that was not shown – on the Immunisation Register. Illness / Allergies: Is your child up-to-date with immunisations? (Please provide verification of all immunisations) Yes No For staff: Immunisation records sighted and details recorded Yes No Medicine

Education in New Zealand. The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, when if received, should be securely destroyed once verified. For Office Use Only Identity record copied for NSN (if required) Immunisation record copied and held with enrolment ID Securely Destroyed: / / Signature: Date of Entry: Date of Exit: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North ShoreChildcare Balclutha. Parents / Guardians Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Emergency Contacts (Adults who are permitted to pick up your child – other than the above) Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Custodial Statement Are there any custodial arrangements concerning your child? Yes No If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required): Name of person/s who CANNOT pick up your child: Name: Name: Name: Name: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North ShoreChildcare Balclutha. Child’s Doctor Name of Medical Centre: Name of Doctor: Phone: Child’s Health Early childhood services are required, as per the Health (Immunisation) Regulations 1995, to ask parents or guardians of a child to provide the Immunisation Record for each child attending their service and record the information from the Immunisation Record – or the fact that was not shown – on the Immunisation Register. Illness / Allergies: Is your child up-to-date with immunisations? (Please provide verification of all immunisations) Yes No For staff: Immunisation records sighted and details recorded Yes No Medicine

Education in New Zealand. The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, when if received, should be securely destroyed once verified. For Office Use Only Identity record copied for NSN (if required) Immunisation record copied and held with enrolment ID Securely Destroyed: / / Signature: Date of Entry: Date of Exit: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North ShoreChildcare Queenstown. Parents / Guardians Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Emergency Contacts (Adults who are permitted to pick up your child – other than the above) Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Custodial Statement Are there any custodial arrangements concerning your child? Yes No If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required): Name of person/s who CANNOT pick up your child: Name: Name: Name: Name: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North ShoreChildcare Queenstown. Child’s Doctor Name of Medical Centre: Name of Doctor: Phone: Child’s Health Early childhood services are required, as per the Health (Immunisation) Regulations 1995, to ask parents or guardians of a child to provide the Immunisation Record for each child attending their service and record the information from the Immunisation Record – or the fact that was not shown – on the Immunisation Register. Illness / Allergies: Is your child up-to-date with immunisations? (Please provide verification of all immunisations) Yes No For staff: Immunisation records sighted and details recorded Yes No Medicine

Education in New Zealand. The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, when which if received, should be securely destroyed once verified. For Office Use Only Identity record copied for NSN (if required) Immunisation record copied and held with enrolment ID Securely Destroyed: / / Signature: Date of Entry: Date of Exit: Any changes to this form must be signed and dated by both the parents♦ Privacy statement ♦ Parent/caregiver and City Impact Church Preschool North Shore. Parents / Guardians Relationship to child: First nameParent/Guardian #1 Details Given names: Surname / family name: Address: Relationship to child: First nameEmail: Phone (h): Phone (w): Phone (m): Address: Post code: Parent/Guardian #2 Details Given names: Surname / family name: Relationship to child: Email: Phone (h): Phone (w): Phone (m): Address: Post code: Parent/Guardian #3 Details Given names: Surname / family name: Relationship to child: Email: Phone (h): Phone (w): Phone (m): Address: Post code: Parent/Guardian #4 Details Given names: Surname / family name: Relationship to child: Email: Phone (h): Phone (w): Phone (m): Address: Post code: Additional person/s who can pick up your child Additional person #1 Additional person #2 Given names: Given names: Surname/family name: Surname/family name: Address: Address: Phone (home) Phone (work) Phone (home) Phone (work) Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone ♦ Emergency contacts (home): Phone (work): Email: Emergency Contacts (Adults who are permitted also able to pick up your child – other than the abovechild) Relationship to childEmergency contact #1 Emergency contact #2 Given names: First Given names: Surname/family name: Surname / Surname/family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Phone (home) Phone (work) Phone (home/} Phone (work) Phone (mobile): ) Email Phone (mobile) Email Emergency contact #3 Emergency contact #4 Given names: Given names: Surname/family name: Surname/family name: Phone (home): ) Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: ) Phone (home) Phone (work) Phone (mobile): Phone (home): Phone (work): Email: ) Email Phone (mobile): Phone (home): Phone (work): Email: ) Email ♦ Custodial Statement Are there any custodial arrangements concerning your child? Yes No If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required): Name of person). Person/s who CANNOT cannot pick up your child: Name: Name: Name: Name: Any Please advise us immediately if there are any changes to this form must be signed and dated by both custodial arrangements concerning your child, or to the parents/caregiver and City Impact Church Preschool North Shore. persons who cannot pick up your child, including because of court Person responsible for paying your fees First name Surname Relationship to child Email Phone (h) Phone (w) Phone (m) Address Post code ♦ Child’s Doctor Name of Medical CentreName: Phone: Name of Doctormedical centre: PhoneAddress of medical centre: In the unlikely event of a medical emergency, I understand my child will be given basic First Aid treatment by centre staff and if necessary, taken to hospital in an ambulance. Parents or a contact person will be notified immediately. Does your child have any specific illness, allergies or dietary requirements? If yes, please specify: ♦ Medicine A category (i) medicine is a non-prescription preparation (such as arnica cream, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet. Note: The service must provide specific information about the category (i) preparations that will be used. Specific names and information about the category (i) provided by our centre: Do you approve category (i) medicines to be used on your child? Yes No Name(s) of specific category (i) medicines provided by the centre that are permitted to be used on my child: Hypercal Healing Cream for cuts and wounds Nivea Sun Sunscreen Parent/guardian signature Date: Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms / circumstances) medicine is to be given. Parent/guardian signature Date: For staff: Individual health plan completed and signed: Yes No To be filled in if your child requires medication as part of an individual health plan, for example for an ongoing condition such as asthma or eczema etc. and is for the use of that child only. For staff: Individual health plan completed and signed: Yes No Name of medicine Method and dose of medicine When does the medicine need to be taken: (state time or specific symptoms): Parent / Guardian signature: About your child Our centre is committed to inclusive education, as per Te Whāriki and the National Education and Learning Priorities (NELP), in particular with reference to Objective 1: Learners at the centre and Objective 2: Barrier free access. This commitment includes working with families and whānau to find ways to reduce barriers to education for disabled learners and those with learning support needs. If your child has an illness or condition, what are the implications or actions to be taken in relation to the child’s illness or condition. For example, does the child’s illness or condition require an individual health plan? For this purpose, please indicate whether you would like to book a meeting to share any health, wellbeing, and/or education and child development information with the centre. This will assist the centre to help your child settle in as well as possible and receive the appropriate health care. Yes, I would like to book a meeting in to discuss my child’s individual health plan. No, I would not like to book a meeting to discuss my child’s individual health plan. Likes and dislikes To help us care for your child and make them feel comfortable at our centre, it is helpful for us to know as much as possible about your child’s needs, e.g. favourite phrases, toys, or songs and what comforts your child; does your child have any dislikes or triggers we should be aware of? Please fill in the ‘Getting to Know You’ form in your child’s profile book. ♦ Child’s Health Please provide verification of all immunisations. Early childhood services are required, as per the Health (Immunisation) Regulations 1995, to ask parents or guardians of a child to provide the Immunisation Record Certificate for each child attending their service and record the information from the Immunisation Record Certificate – or the fact that it was not shown – on the Immunisation Registerimmunisation register. Illness / AllergiesIllness/allergies: Is your child up-to-up to date with immunisations? (Yes No Please provide verification of all immunisations) Yes No . For staff: Immunisation records sighted sighted, and details recorded recorded: Yes No MedicineEnrolment Details Xxxxx Xxxx Preschool undertakes to deliver quality early childhood education and care to your child in accordance with our Philosophy Statement, while ensuring the adults working in our service are healthy and similarly kept safe in accordance with our responsibilities under the Health C Safety at Work Act 2015. The service provider is required to eliminate and/or minimise risks to health and safety so far as is reasonably practicable. The term of this agreement, and your child's enrolment in our service, is from the Date of Enrolment to the Intended Date of Exit set out below. However, the continued enrolment of your child until the Intended Date of Exit (often the child’s 5th birthday) is not guaranteed. You may end your child's enrolment with us, and this agreement, at any time by notifying us in accordance with our enrolment policy. As set out, we may review your child's enrolment with us, and may end their enrolment, and this agreement before the Intended Date of Exit: • if you have not paid fees • because of ongoing absences that have affected the funding we receive for your child (if applicable) • if we consider that this would be in the best interests of the child, other children at the centre or the adults working in our service. We will always make reasonable efforts to work with you to resolve any issues that have arisen before ending your child's enrolment early for one of the reasons set out above. We will give you reasonable notice (to the extent possible, in the circumstances) if we decide to end your child's enrolment before the Intended Date of Exit. The enrolment of your child in our services is also dependent on the service continuing to be licensed, operational, and fully compliant with regulatory requirements including legal obligations in the Health and Safety at Work Act 2015. ♦ Enrolment details Date of enrolment dd / mm / yyyy Date of entry dd / mm / yyyy Date of exit dd / mm / yyyy Monday Tuesday Wednesday Thursday Friday Total no. of hours: Times enrolled ♦ 20 Hours ECE Please note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week, and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. For 20 Hours ECE fill out the boxes below with the hours attended e.g. 6 hours Monday Tuesday Wednesday Thursday Friday Total no. of hours: 20 Hours ECE at this service 20 Hours ECE at another service Parent / guardian signature Date ♦ 20 Hours ECE Attestation