Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, 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. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by the Service: Centre to cross out any medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) ▪ Calendula Cream (if used, the treatment will be noted in the Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Parent/Guardian Signature: Date: / / Category (ii) Medicines Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc.) or non-prescription (such as paracetamol liquid, cough syrup and teething gels 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 as 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. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / /

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Medicines. To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only. For staff: Individual health plan sighted and a copy taken: Tick One: Yes No Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Enrolment Details: Date of Enrolment:____ /____ / ___ Date of Entry: ____ /____ / ____ Date of Exit: ____ /____ / ____ 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. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: ____________________________ Date: ____ /____ / ____  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? Tick One Yes No 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. If your child is absent for three weeks or more funding will cease on the fourth week and you will be liable to pay the non-funded child daily rate as per fee schedule. If your child is absent because of sickness then a medical certificate will need to be supplied for funding to continue, until normal bookings commence. 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 Future Kids. Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Financial Det...

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Medicines. 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: / /

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Medicines. 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. Do you approve category (i) medicines to be used on your child? Tick One Yes No Name/s of specific category (i) medicines that can be used on my child, provided by service: ▪ Arnica [bruising] ▪ Savlon [cleaning wounds] ▪ Anthisan [insect bites and other itches] ▪ Saline Solution ▪ ▪ Parent/Guardian Signature: Date: / / Category (ii) Medicines 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: / _ / Category (iii) Medicines To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only. For staff: Individual health plan sighted and a copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (State time or specific symptoms) Parent should review and update these plans every 3 months Treatment Consent: In signing this enrolment form, I authorise the management of the centre to administer medication provided by me for my child from time to time and in the event of any illness, medical condition or accident or where the child’s health may be at risk, I authorise the management of Kindy Cottage to seek appropriate professional or medical advice or treatment as they consider necessary for the best interest of the child. Parent/Guardian Signature: Date: / / In the event of your child receiving a minor injury at school, the following protocol will take place:- • Child wil...

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Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If your child should require the administering of category (iii) medication, please complete the Category (iii) Medication Plan which is included in your enrolment pack. Parent/Guardian Signature: Date: / / Medication Administering Agreement Form Parent consent I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health and Wellbeing Checks: Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / P...

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