Common use of Medicines Clause in Contracts

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 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: / /

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 first aid’ treatment of minor injuries and provided by the service and kept in the first first aid cabinet. Note: The service must provide specific 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 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) child ª ª ª ª 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 and teething gels etc.) medicine that is used for a specific specific period of time to treat a specific 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 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 specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: Date: / / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: Date: / / t Enrolment Details: Date of Enrolment: / / Date of Entry: / / Date of Exit: / / Please Note: 20 Hours ECE is for up to six hours per day, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, 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 • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) 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 drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, 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 oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as 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. 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: / / Category (iii) Medicines 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, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare Queenstown. 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. The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, 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 • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) 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 drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, 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 oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as 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. 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: / / Category (iii) Medicines 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, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Preschool North Shore. 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. The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / / 8am – 12pm 1pm – 5pm

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, 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 • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) 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 drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, 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 oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as 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. 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: / / Category (iii) Medicines 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, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare North Shore. 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. The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / /

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid/cream, 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 • Arnica Cream (iAnti-Flamme brand) preparations that will be used. • Antiseptic Cream/Spray (Thursday Plantation brand) • Insect Bite Cream (Anthisan brand) 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 drops, paracetamol, cough syrup, etc.) or non-prescription (such as paracetamol liquidBonjela, cough syrup and teething gels nasal spray, 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 oronly, or in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as 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. 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: / / Category (iii) Medicines 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, eczema and/or allergies. Does your child require an individual health plan? Yes No For staff: Individual health plan completed Yes No Name of Medicine: Method and dose of medicine: When does the medicine need to be taken (specific time and/or symptoms: Parent/Guardian Signature: Date: / / Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare Balclutha. 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. The minimum number of sessions per week at this centre is 2 sessions per week (inclusive of School Term Break) Requested Start Date: / / 8am – 12pm 1pm – 5pm

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. This includes, approved sunblock, insect repellent and saline. 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 Serviceservice: Centre to (please cross out any medicines that are you do not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Registerconsent to) ▪ • Sunblock • Antiseptic Cream • Insect Repellent • 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 Treatment • Arnica 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) • Saline Solution Parent/Guardian Signature: Date: 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 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 medication 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 plan, for example for an ongoing condition such as asthma, eczema, or diabetes, etc and is for the use of that child only. If your child should require the administering of a requires category (iiiii) medication, the Category (ii) medicines you are required to complete a ‘Medication Register Category iii’ form which forms part of an individual plan for your child. Complete Asthma Details and Action Plan Form if your child has Asthma Yes No Complete Additional Needs Information Form if your child has eczema, diabetes, etc Yes No Complete Medication Register Category iii Form if your child requires category 3 medicines Yes No For staff: Individual health plan sighted and a copy taken Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (state time or specific symptoms) Yes No Parent/Guardian Signature Date / / Xxxxx’s first name Surname / family name Date of enrolment / / Date of entry / / Date of exit / / (forms received) (join date) (leave date) 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 Total Hours Times Enrolled eg 9:00am – 5:30pm For 20 Hours ECE fill out boxes below with hours attested eg. 6 hours Total Hours 20 hours ECE at this service 20 hours ECE at another service Parent/Guardian Signature Date / / Change of Days / Times of Enrolment Effective date of change / / Days Enrolled Monday Tuesday Wednesday Thursday Friday Total Hours Times Enrolled eg 9:00am – 5:30pm For 20 Hours ECE fill out boxes below with hours attested eg. 6 hours Total Hours 20 hours ECE at this service 20 hours ECE at another service Parent/Guardian Signature Date / / 20 Hours ECE Attestation 1. Is your child receiving 20 Hours ECE for up to 6 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. • 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 / / 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 this BestStart Service. Parent/Guardian Signature Date / / Permissions I understand observations will be completed on my child by BestStart teachers to assist in planning a daily basisprogramme Yes No to meet the needs of my child and the group. Parent/Guardian Signature: Date: I understand that I am able to view these at any time. I understand observations will be completed on my child by Early Childhood students in the course of their training. These observations will not include the child’s name and, copies of the observation can be forwarded to parents on Yes No request. I give permission for my child’s learning journey to be documented, photographed / /filmed for assessment purposes, available on Storypark, centre display, management notice boards and to be included in other children’s Yes No portfolios where applicable. I agree to my child being photographed / filmed by BestStart staff or external media groups in association with BestStart whilst in the centre or out on excursion for news stories. These stories / images could appear on TV, Yes No printed publications or digital places including internet, websites, social media or BestStart staff intranet.

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 Serviceservice: 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) [bruising] ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) Savlon [cleaning wounds] ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) Anthisan [insect bites and other itches] ▪ Paw Paw Ointment (if used, the treatment will be noted in the Injury/Incident/ Register) Saline Solution ▪ 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 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 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. If Parent/Guardian Signature: Date: / _ / 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 require review and update these plans every 3 months Treatment Consent: In signing this enrolment form, I authorise the administering management of a category (ii) medicationthe 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 Category (ii) Medication Register will child’s health may be completed on a daily basisat 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: / // • Child will be comforted and a qualified First Aider (all teachers on duty have current practicing First Aid Certificates) will carry out any required treatment. • Any scrapes and cuts will be cleaned, disinfected with antiseptic, HYPERCAL cream will be applied and a plaster will be placed on the injury. • Any insect bites will be treated with ANTHISAN cream. • Any bruise will be treated with an ice pack and application of ARNICA cream. • A comprehensive accident report will be completed and brought to your attention when collecting your child from school. This form will be signed by staff and parent and you will receive a copy.

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 Centre and kept in the first aid cabinet. Note: The service Centre 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 ServiceCentre: 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 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 serviceCentre. I acknowledge that written authority as 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. If Parent/Guardian Signature: _ Date: / _ / _ To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _ ♦ Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ _ /_ / Date of Exit: / _ / _ How did you hear about us: Please select centre: Tick One Central Queenstown Remarkables Park Please Note: 20 Hours ECE is for up to six hours per day, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this Centre Total hours: 20 Hours ECE at another Centre Total hours: Parent/Guardian Signature: Date: / /_ / _ 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this Centre? Tick One Yes No 2. Is your child receiving 20 Hours ECE at any other Centres? Tick One Yes No If yes to either or both of the above, please sign to confirm that:

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 Serviceservice: 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 (topically for small bumps and bruises)  Yes  No  Petroleum Jelly / Vaseline (Used for emergency nappy rash and sticky noses)  Yes  No  Insect repellent (to prevent insect bites)  Yes  No  Vicks Vapo Rub (applied to body to help with blocked noses)  Yes  No  Sunscreen (used for sunburn protection (Please supply your own if usedyour child has sensitive skin)  Yes  No  Any medications you may want us to use regularly that you have supplied add here please  Swedish Bitters cream, the treatment will be noted in the Nappy for itchy bites and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) hives  Yes  No  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 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 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. 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: / /

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 Serviceservice: 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    P arent/Guardian Signature: Date: / / 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 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. If P arent/Guardian Signature: Date: / / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Yes Tick One: No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationP arent/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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. ParentDays Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service 20 Hours ECE at another service Total hours: Total hours: P arent/Guardian Signature: Date: / / 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. P arent/Guardian Signature: Date: / / 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 [insert name of service]. P arent/Guardian Signature: Date: / / If you request Optional Charges, this agreement must be included as part of your service’s Enrolment Agreement Form.

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 Serviceservice: 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 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 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. If your child should require Two staff members will check the administering of a category (ii) medication, medicine prior to it being given to the Category (ii) Medication Register will be completed on a daily basischild. Parent/Guardian Signature: Date: / / 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/Guardian Signature: Date: / /

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 Serviceservice: 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 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 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. If Parent/Guardian Signature: _ Date: /_ / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: _ Date: /_ / 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 Category (ii) Medication Register will be completed on a daily basisabove, 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: /_ / 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 [insert name of service]. Parent/Guardian Signature: _ Date: /_ / 1. The optional charge is for: (give details of specific activities or items, and their costs) ▪ Upgrading of facilities and play area ▪ Resources, equipment and staffing over and above the basic requirement. 2. I understand that if I agree to pay for the optional charge, Small miracles Preschool may enforce payment. 3. The agreement to pay the optional charge will last for: On going agreement for term of Small Miracles attendance.

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 Serviceservice: 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 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 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. If Parent/Guardian Signature: _ Date: / _ / _ To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / _ / _ 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: / _ / _ 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 [insert name of service]. Parent/Guardian Signature: _ Date: / _ / _

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolinsavlon, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first first aid’ treatment of minor injuries and provided by the service and kept in the first first aid cabinet. Note: The service must provide specific 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 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) child ª ª ª ª 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 and teething gels etc.) medicine that is used for a specific specific period of time to treat a specific 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 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 specific symptoms/circumstances) medicine is to be given. If Parent/Guardian Signature: Date: / / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: Date: / / t Enrolment Details: Date of Enrolment: / / Date of Entry: / / Date of Exit: / / Please Note: 20 Hours ECE is for up to six hours per day, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / /

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 Upon any discovery of specific category (i) medicines that can head lice on your child at Let’s Grow do you approve for a treatment spray to be used on my applied? If needed to you approve for a nappy rash cream such as ‘Curash’ to be applied to your child, provided by the Service? Please circle: 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) Please circle: Yes Yes / No / No 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 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 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. If Parent/Guardian Signature: Date: / / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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. Additional centre notes: The 20 Hours ECE is calculated by the Ministry of Education to cover the 'standard level of care' this standard level includes: only 50% qualified staff (we have 80-100%), we also supply food which is not standard, the Category 20 Hours ECE is capped at 6 hours per day and as the funding alone is not enough to cover costs for the extras that we provide we have a chargeable portion built into the day, all bookings for over 3's are for a minimum 6.5 hours. Let’s Grow does not have an optional charge for the 20 Hours ECE. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: (ii6.5 hours per day minimum for over 3’s) Medication Register will be completed on a daily basis. Total hours: 20 Hours ECE at this service 20 Hours ECE at another service Total hours: Total hours: Parent/Guardian Signature: Date: / / 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? No No

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 Serviceservice: 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 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 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. If Parent/Guardian Signature: _ Date: / _ / _ To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this Total hours: service 20 Hours ECE at Total hours: another service Parent/Guardian Signature: Date: / /_ / _

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 Serviceservice: 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 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 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. If Staff: Medication agreement to be completed and signed, for each incident □ Yes □ No Parent/Guardian Signature: Date: / / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / / 1. I understand that the teachers are only responsible for this child during Kindergarten sessions. I am responsible for seeing that this child gets safely to and from Kindergarten. Yes No 2. I understand that I will need to give written approval for any time this child has to travel for a trip or Excursion. (by bus or taxi) Yes No

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 service:  Sun Block  Insect Bite Treatment  Arnica Cream  Organic Coconut Oil If permission is given to the Service: Centre to cross out any following category (i) 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 usedused on your child, 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) provided by you:  Non-prescription creams  Talcum powder 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 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 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. If Parent/Guardian Signature: Date: / / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) Please advise the centre if specific training is required to administer your childs medication, the Category (ii) Medication Register will be completed on a daily basis. Parent/Guardian Signature: Date: / /

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 Serviceservice: 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    P arent/Guardian Signature: Date: / / 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 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. If P arent/Guardian Signature: Date: / / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Yes Tick One: No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationP arent/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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. ParentDays Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service 20 Hours ECE at another service Total hours: Total hours: P arent/Guardian Signature: Date: / / 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. 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. P arent/Guardian Signature: Date: / / 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 [insert name of service]. P arent/Guardian Signature: Date: / / 1. The optional charge is for: (give details of specific activities or items, and their costs)   2. I understand that if I agree to pay for the optional charge, [insert name of service] may enforce payment. 3. The agreement to pay the optional charge will last for: [insert time].

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 service: ▪ Naturo Pharm Arnica Cream ▪ Oasis Sun Block ▪ Anthisan Insect Bite Treatment ▪ Naturo Pharm Calendula Cream If permission is given the Service: Centre to cross out any following category (i) medicines that are not used in Centre. ▪ Arnica (if used, the treatment will be noted in the Injury/Incident/ Register) used on your child, provided by you ▪ Insect Bite Cream/Spray (if used, the treatment will be noted in the Injury/Incident/ Register) Non –prescriptive creams ▪ 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) Baby powder 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 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 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. 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: /_ / 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/Guardian Signature: _ Date: /_ / Enrolment Details: Date of Enrolment: / _ / _ Date of Entry: /_ / _ Date of Exit: / _ / Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: Please note next section is for children aged 3 to 5 years only: 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 funding fill out the 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: /_ / 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:

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 Serviceservice: 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) cream ▪ 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 Zinc and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) castor oil 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 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 M ori (Māori M ori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as 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. If Parent/Guardian Signature: _ Date: / _ / _ To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this Total hours: service 20 Hours ECE at Total hours: another service Parent/Guardian Signature: Date: / _ / _ 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 No 2. Is your child receiving 20 Hours ECE at any other services? Tick One Yes 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: / _ / _ Date: / _ / _ Parent/Guardian Signature: _ 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 Miniland. ♦ Dual Enrolment Declaration ▪ Excursions: Permission for the child to take part in regular excursions to Greenhithe Primary school and/or other locations as advised (under the conditions stated in the service’s excursions policy) ▪ Photo/video: Permission for the child to be photographed for the purposes of assessment, planning and evaluation. Photographs and videos will be used for the purpose of Storypark and classroom wallboards. For anything else we will seek extra permission.

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 Serviceservice: 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) ▪ • Bonjela • 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) ▪ Cream • Nappy Cream • 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) • Anthisan • Non-Lanolin Fatty Cream 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 Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as 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/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: / / 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: 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: Date: / / Dual Enrolment Declaration I hereby declare that my child is not enrolled at another early childhood institution at the same times that he/she is enrolled at Tiny Tuis Early Learning Centre. Parent/Guardian Signature: Date: / / Enrolment Details Childs Age at Entry: Date of Entry: / / Date of Enrolment: 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: Mon Tue Wed Thu Fri Total Hours Times Enrolled: Parent/Guardian Signature: Date: / / For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours

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 Serviceservice: 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) Cream ▪ Antiseptic Cream/Liquid (i.e. Savlon, Dettol or similar) (if used, the treatment will be noted in the Injury/Incident/ Register) Cream ▪ 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) Castor cream 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 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 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. If Parent/Guardian Signature: Date: / _ / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medication, the Category (ii) Medication Register will be completed on a daily basisPlease also fill in an ongoing medicine approval form. 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: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / /

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 Serviceservice: 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) Cream ▪ 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 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 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. If Parent/Guardian Signature: _ Date: /_ / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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 Times Enrolled: Total hours: Morning 8:30 – 13.30 U3 Afternoon 12 -3.30 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: _ Date: /_ / 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 Category (ii) Medication Register will be completed on a daily basisabove, 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 Date: /_ / 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: ------- 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 Leigh Community Preschool. Parent/Guardian Signature: _ Date: /_ / 1. The charge is: ▪ To maintain ratios, of teachers to children to ensure quality of care. Leigh Preschool is a unique learning environment with low rolls because we know that a peaceful environment is paramount for healthy brain development in children. The MOE requirement is to have 1 :10 Over 2’s and 1:5 under 2’s. Xxxxx preschool is teacher to child ratios of 1:6 over 2’s – 1:8 Over 3’s and 1:3 Under 2’s to ensure a peaceful environment. (See the attached flowchart) ▪ It is also for the 7th hour of care after 6 hours subsidised ECE funding. The subsidy is limited to 6 hours per day and up to 30 hours per week. ▪ All children over 3 years on the ECE funding must enrol for a minimum of 2 full days. 2. I understand that if I agree to pay for the charge, Leigh Community Preschool may enforce payment. 3. The agreement to pay the charge will last until your child turns 5 years old. 4. The rules about making changes to the agreement are: ▪ That you provide 2 weeks written notice to opt out of the 20 hours ECE funding. 5. I agree to pay the charge for the activities/items specified in this enrolment agreement form. Parent/Guardian Signature: _ Date: /_ / /This enrolment agreement is exclusive of school term breaks. OUR FEES ARE CURRENTLY SET AT: UNDER THREES $35 Half Day $49 Full Day 3 - 5 YEAR OLDS who are receiving the 20 Hours ECE Subsidy (this charge is to cover higher ratio of teachers to children than MOE requirements and the 7th hour of care on full days where 6 hours subsidy is claimed) $21 Full Day only Please note: Fees are to be paid a Fortnight in advance of enrolment / start date. Please also see our information booklet attached. WINZ offer a Childcare Subsidy which pays a portion of your fees as a part of their “Working For Families’ package. You may be eligible for WINZ if your child attends more than 20 hours (it is income tested) We have the forms available and/or contact the local WINZ branch. See FEES info for special rates in main booklet. Fees Agreement • In signing this enrolment form I agree to pay the fees on the basis of the fee schedule that is current at the time and I will pay, in advance, in accordance with the Fee Policy of the Centre. • I acknowledge and agree to pay the appropriate fee for an enrolled day even if unable to attend. • I accept the “late pickup fee” for each 15 minutes (or part thereof) late after my child’s session closing time.

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 Serviceservice: 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)  Antihistamine cream  Burn Aid  Savlon  Sun cream 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 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 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. If Parent/Guardian Signature: _ Date: / _ / _ To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this Total hours: service 20 Hours ECE at Total hours: another service Parent/Guardian Signature: Date: / _ / _ Date: / _ / _ Parent/Guardian Signature: _ The Centre has an enrolment fee of $45.00. This is an administration fee that covers the cost of setting up for your child in the centre. The fee is non-refundable and is required prior to your child starting in the centre. All fees are the responsibility of the family and are able to be paid weekly on invoice day. Winz payments must be covered by the family until Winz payments start. Any legal fees incurred in the process of collection of unpaid fees will be covered by the family.  Enrolment Fee and WINZ Payments

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 Centre and kept in the first aid cabinet. Note: The service Centre 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 ServiceCentre: 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 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 serviceCentre. I acknowledge that written authority as 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. If Parent/Guardian Signature: _ Date: / _ / _ To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/Guardian Signature: _ Date: / _ / _  Enrolment Details: Date of Enrolment:_ / / Date of Entry: _ _ /_ / Date of Exit: / _ / _ How did you hear about us: Please Note: 20 Hours ECE is for up to six hours per day, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this Centre Total hours: 20 Hours ECE at another Centre Total hours: Parent/Guardian Signature: Date: / /_ / _ 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this Centre? Tick One Yes No 2. Is your child receiving 20 Hours ECE at any other Centres? Tick One Yes No If yes to either or both of the above, please sign to confirm that:

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 Cream ▪ Anthisan (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/ Registerinsect bite treatment) ▪ 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 Baby Nappy and Toileting Chart) ▪ Cornflour (if used, the treatment will be noted in the Nappy and Toileting Chart) Balm - Ecostore 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 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 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. If Parent/Guardian Signature: Date: / _ / To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted, and a category (ii) medicationcopy 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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / /

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, child provided by the Serviceservice: 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) ▪ Treatment 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 Arnica 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 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 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. If I will keep my child at home for the first 24 hours after starting any prescribed antibiotics. Parent/Guardian Signature: _ Date: / _ / _ To be filled in if your child should require 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 administering use of that child only. For staff: Individual health plan sighted and a category copy taken: Tick One: Yes No Name of medicine: Method and dose of medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParent/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, the Category (ii) Medication Register will up to 20 hours per week and there must be completed on no compulsory fees when a daily basischild is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this Total hours: service 20 Hours ECE at Total hours: another service Parent/Guardian Signature: Date: _ / // _ 1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service?

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) , nappy rash cream/talc, sunblock 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. NoteParents supplying own SUNBLOCK: The service must provide specific information about the category (i) preparations that will be used. Please state which/if any treatments you do NOT want used on your child: 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) child YES NO 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 and teething gels etc.) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a the parent for the use of that child only or, in relation to Rongoa Māori Maori (Māori Maori plant medicines), that is prepared by other adults at the service. I acknowledge that written authority as 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. If Parent/Guardian Signature: Date: / / To be filled in every 3 months if your child should require 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 administering use of a category that child only Signed Agreement or acknowledgment for the administration of medication to be kept in Medical Folder & renewed every 3 months: YES NO Name of Medicine: Method and dose of Medicine: When does the medicine need to be taken: (iiState time or specific symptoms) medicationParents/Guardian Signature: Date: / / • An annual non-refundable administration fee of $20 per family will be charged on enrolment of each year to cover administration costs and booking changes. This will be charged before any new enrolments are accepted. • I agree to pay fees at the rates set by the Methven Pre School. Accounts are emailed monthly or issued weekly or fortnightly if requested, fees are due for payment monthly. Interest will be charged at 10% of your overdue account per month. • Children may not be allowed to attend Pre School if accounts are outstanding for 2 months or more. If no parental/caregiver contact occurs, the Category (ii) Medication Register debt will be completed passed to a debt collector. All costs and expenses which we may incur will be added to the to the total amount owing. • Fees are charged for all operational days your child is booked, regardless of whether they attend or not. Fees are not charged over the Christmas/New Year holiday period, statutory public holidays, teacher only days or emergency closure days. • Please advise the Pre School administration if your child will be away on holiday. There is a daily basistwo week holiday discount of 50% given annually which applies to permanent bookings. This must be taken consecutively (one week or two weeks, not as single days). To receive this discount you must notify the centre at least one week prior to the holiday. This does not apply to children receiving/using any 20 hours ECE. • I understand that after 3 consecutive weeks of absence, entitlement to Ministry of Education or WINZ subsidy ceases and FULL fees are charged after this period until your child returns to the Pre School. • Late pick-up fee: No notification in regards to any late pick-ups incur a $15 per quarter hour penalty charge. Bookings can be extended in ½ hour increments only. • No notification of cancelled attendance on permanent or casual bookings incurs a $30 non notification penalty charge. Parent/Guardian Signature: Date: / / BOOKINGS: • I understand that the hours of operation of the Methven Pre School are Monday to Friday 8am to 5pm. • Booking times apply: minimum 9am – 1pm, 1pm – 4.30pm, or 9am – 3pm. These times can be extended on a permanent or casual basis, subject to availability. Bookings must start or finish on the hour or ½ hour. • The minimum childcare attendance is two days/sessions per week, this enables children to have regular and meaningful relationships with other children and staff. • Two weeks’ notice must be given for cancellation of a permanent booking or full fees will be charged. • Casual bookings cannot be made more than 2 weeks in advance. (Management discretion). • Methven Pre School will not offer make-up days. Parent/Guardian Signature: Date: / / • The option for morning and / or afternoon teas is available, please see Opt IN/Out form for details. Permissions (please tick the boxes for those you GIVE consent too) For the centre staff to carry our written observations and use digital images and/or videos of my child for the purposes of program planning, assignments and recording. For students who enter the centre to carry out written observations and use digital images of my child for training purposes. For my child’s photograph to be used in newspaper/media articles, on the Methven Pre School website, Pre School’s Facebook page and group learning (see storypark permission settings) See Privacy Statement. For my child to be taken out of the Pre School on impromptu outings/walks, adhering to staff/child ratios and centre procedures. All children will be wearing high visibility vests and sunhats/coats as necessary For my child to participate in Vision and Hearing testing. • I have viewed the sleeping facilities and read the sleeping policy, if applicable. (printed in information booklet) • I agree, as per the rules of the Methven Pre School Constitution, to become a member of the Methven Creche Association Incorporated and agree to the payment of $1 per annum per family, this will be charged to your account. • Legislative requirements are displayed in reception. Policies are available on request, and are reviewed monthly according to the policy review schedule or it can also be found on our website xxx.xxxxxxxxxxxxxxxx.xxx.xx • Parents/caregiver/whanau will not physically discipline any child on the Centres property. All children will be treated with dignity and respect as per the centres policy on developing social competence. • All information concerning the child enrolled is kept in a secure environment and is available on request. Personal records are destroyed after 7 years. • Children showing signs of sickness or infectious illnesses must be excluded from the centre as per Ministry of Health, medical advice and centre policy. (refer emergency pick up on page 2) • Authorisation is given for STAFF ONLY to attend to toileting requirements while my child is attending the Pre School. • I acknowledge that my child enters the Pre School at their own risk and although proper and experienced care is given at all times, this Pre School cannot accept responsibility for misadventures either at the Pre School or on outings. • I understand that I will be required to provide signed consent for any excursion requiring transport. All transport adheres to legal requirements. • Signing up to Storypark is mandatory for the recording of children’s learning and development. Please see information booklet.

Medicines. A category (i) medicine is a non-prescription preparation (such as arnica cream, lanolin, antiseptic liquid, insect bite treatment) that is not ingested, but used for the ‘first aid’ treatment and prevention of minor injuries and injuries. It is 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 give permission for category (i) medicines to be used on your child? Tick One Please circle Yes No Name/s of specific If permission is given, the following category (i) medicines that can could be used on my your child, provided by the ServiceCentre: Centre to cross out any medicines that are not used in Centre. ▪ ● NaturoPharm Arnica plus cream or spray ● NaturoPharm Calendula cream ● Dettol Antiseptic ● Sunblock ● Sudocream (if used, the treatment will be noted in the Injury/Incident/ Registerxxxx & xxxxxx oil) ▪ 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 ● Lavender oil ● Paraderm Plus First Aid 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) ● Corn flour for nappyrash Parent/Guardian Signature: Date: / / Category Catergory (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 oronly, or in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults a qualified teacher at the serviceCentre. I acknowledge that written authority as 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. If your child should require the administering of a category (ii) medication, the Category (ii) Medication Register will All medicine must have original label attached and must be completed on a daily basisreadable to staff. Parent/Guardian Signature: Date: / / 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: Please circle Yes No Name of Medication: Method and dose of medication: When does the medicine need to be taken? (State specific time or specific symptoms) Parent/Guardian Signature: Date: / /