Hours ECE Attestation. 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick One Yes No
Hours ECE Attestation. 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick One Yes No 2. Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the above, please sign to confirm that: Your child does not receive more than 20 hours of 20 Hours ECE per week across all services. Your authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Agreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibility for 20 Hours ECE. You consent to the early childhood education service providing relevant information to the Ministry of Education, and to other early childhood education services your child is enrolled at, about the information contained in this box. Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by the parent/guardian. Dual Enrolment Declaration Please circle correct statement: I hereby declare that my child is / is not enrolled at another early childhood institution at the same times that he/she is enrolled at Champion Kids. Parent/Guardian Signature: Date: / / Child’s strengths, interests and preferences Please tell us about your child’s strengths, interests and preferences:
Hours ECE Attestation. 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick one Yes No 2. Is your child receiving 20 Hours ECE at any other services? Tick one Yes No If yes to either or both of the above, please sign to confirm that: - Your child does not receive more than 20 hours of 20 Hours ECE per week across all services. - You authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Agreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibility for 20
Hours ECE Attestation. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Yes No Is your child receiving 20 Hours ECE at any other services? Yes No If yes to either or both of the above, please sign to confirm that: Your child does not receive more than 20 hours of 20 Hours ECE per week across all services. Your authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Agreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibility for 20 Hours ECE. You consent to the early childhood education service providing relevant information to the Ministry of Education, and to other early childhood education services your child is enrolled at, about the information contained in this box. Parent/Guardian Signature: Date: d d / m m / y y y y Health: Illness/allergies: Is your child up-to-date with immunisations? (Please provide verifications of all immunisations) Yes No Immunisations record photocopied by Little Explorers and details recorded: Yes No Hearing/Vision Testing I give permission for my child to have their ears and eyes tested periodically by the visiting Yes No vision and hearing technician and for my contact information to be shared with them. I hereby give permission to the staff of Little Explorers, in the event of an emergency to seek any Yes No emergency medical practitioner at my expense. I give permission for my child to be taken to an alternative location in the event of an emergency. Yes No For example a civil defence post. I give permission for the centre to apply sunscreen to my child. (I will provide my own if required Yes No due to allergies) I will not bring my child to the centre in the event of sickness or any infectious illness and understand a doctor’s certificate may be required prior to returning with some illnesses. Parent/Guardian Signature: Date: d d / m m / y y y y Medicine:
Hours ECE Attestation. 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Yes No 2. Is your child receiving 20 Hours ECE at any other services? Yes No If yes to either or both of the above, please sign to confirm that: • Your child does not receive more than 20 hours of 20 Hours ECE per week across all services. • Your authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Agreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibility for 20 Hours ECE. • You consent to Smart Start Montessori providing relevant information to the Ministry of Education, and to other early childhood education services your child is enrolled at, about the information contained in this box. Parent/Guardian Signature Date DUAL ENROLMENT DECLARATION: I hereby declare that my child is / is not enrolled at another early childhood institution at the same times that he/she is enrolled at Smart Start Montessori. Parent/Guardian Signature Date Days Enrolled Monday Tuesday Wednesday Thursday Friday Total hours TimesEnrolled 20 Hours ECE at this service 20 Hours ECE at another service
