Common use of Medicines Clause in Contracts

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

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. For staff: Individual health plan sighted and a copy taken: Tick One: Yes No Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Enrolment Details: Date of Enrolment:____ /____ / ___ Date of Entry: ____ /____ / ____ Date of Exit: ____ /____ / ____ Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: ____________________________ Date: ____ /____ / ____  20 Hours ECE Attestation: Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the above, please sign to confirm that: Your child does not receive more than 20 hours of 20 Hours ECE per week across all services. Your authorise the Ministry of Education to make enquiries regarding the information provided in the Enrolment Agreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibility for 20 Hours ECE. You consent to the early childhood education service providing relevant information to the Ministry of Education, and to other early childhood education services your child is enrolled at, about the information contained in this box. If your child should require is absent for three weeks or more funding will cease on the administering fourth week and you will be liable to pay the non-funded child daily rate as per fee schedule. If your child is absent because of category (iii) medicationsickness then a medical certificate will need to be supplied for funding to continue, please complete the Category (iii) Medication Plan which is included in your enrolment packuntil normal bookings commence. Parent/Guardian Signature: _____________________________ Date: ____ /____ / / I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication ____  Dual Enrolment Declaration I hereby declare that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child is/is not enrolled at another early childhood institution at the same times that Ihe/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as she is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medicationsenrolled at Future Kids. Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Financial Details. Please circle person to invoice: Mother/Father/Guardian/Other – Name: Email address:  Statutory Holidays / Service Provider SignatureTerm Breaks This enrolment agreement is inclusive of school term breaks. Future Kids is not open on the following public holidays if they fall on a week day Policy Statement: Date: / / Health Services visit Future Kids Preschool has a number of policies that set out the Centre regularly procedures that are in place for the care and education of the children who attend. We strongly urge you to carry out child wellbeing checks which may include hearing read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and vision, before school checks, dental and general health checks. Do understand how you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to can have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake input in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finishedpolicy reviews.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If your 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: / / • Excursions: Children will be taken on excursions that contribute to the educational programme. A consent form will be given to parents for planned excursions. When the occasion and opportunity arises, we take groups of children to Fairfield Park or Fairfield Reserve, these are our regular walks. I agree to this child should require going on walking excursions to support their Early Childhood Education and understand I will be required to give written consent for any excursion that isn’t a regular walk, or the administering child is required to travel by motor vehicle. The following ratios of category adults to children are maintained: Over 2 - A maximum of 4 children to 1 adult - A minimum of 1 adult being the teacher - A minimum of 2 adults on any excursion Agree / Disagree (iiiPlease circle which applies) medication, please complete Parent / Guardian Signature: Date: / / ▪ I give permission for this child’s name and photo to be published in Centre Newsletters. Agree / Disagree (Please circle which applies) Parent / Guardian Signature: Date: / / ▪ I understand that ICT is part of the Category Centre programme and that photographs/videos will be taken of this child for their online assessment page (iiiprotected/private) Medication Plan to document their learning via Storypark. Parent / Guardian Signature: Date: / / ▪ I give permission for any such photographs/videos to be used for publicity purposes. Agree/ Disagree (Please circle which is included in your enrolment packapplies) Parent / Guardian Signature: Date: / / ▪ I give permission for such photographs to be uploaded to our public Facebook page. Agree / Disagree (Please circle which applies) Parent/Guardian Signature: Date: / / ▪ Reducing food related choking young children - I have received a copy of the Ministry of Health guidance to reduce the risk of food related choking. Parent/Guardian Signature: Date: / / I/we (please print first ♦ 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 last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medicationsthere must be no compulsory fees when a child is receiving 20 Hours ECE funding. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finished.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. For staff: Individual health plan created Yes No Manager notified Yes No Team Leader notified Yes No Qualify for a EC12/13 exemption – if yes complete forms for doctors signing Yes No Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Enrolment Details: Date of Enrolment:____ /____ / ___ Date of Entry: ____ /____ / ____ Date of Exit: ____ /____ / ____ Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total hours: 20 Hours ECE at this service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: ____________________________ Date: ____ /____ / ____  20 Hours ECE Attestation: Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? 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. If your child should require is absent for three weeks or more funding will cease on the administering fourth week and you will be liable to pay the non-funded child daily rate as per fee schedule. If your child is absent because of category (iii) medicationsickness then a medical certificate will need to be supplied for funding to continue, please complete the Category (iii) Medication Plan which is included in your enrolment packuntil normal bookings commence. Parent/Guardian Signature: _____________________________ Date: ____ /____ / / I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication ____  Dual Enrolment Declaration I hereby declare that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child is/is not enrolled at another early childhood institution at the same times that Ihe/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as she is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medicationsenrolled at Future Kids. Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Financial Details. Please circle person to invoice: Mother/Father/Guardian/Other – N ame: E mail address:  Statutory Holidays / Service Provider SignatureTerm Breaks This enrolment agreement is inclusive of school term breaks. Future Kids is not open on the following public holidays if they fall on a week day Policy Statement: Date: / / Health Services visit Future Kids Preschool has a number of policies that set out the Centre regularly procedures that are in place for the care and education of the children who attend. We strongly urge you to carry out child wellbeing checks which may include hearing read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and vision, before school checks, dental and general health checks. Do understand how you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to can have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake input in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finishedpolicy reviews.

Medicines. To be filled in Children require an individual health plan if they require medication for an on-going condition such as asthma or eczema etc. Does your child requires medication as part of require an individual health plan? Tick One: If Yes, teachers will follow up to develop this plan with you Yes 🞏 No 🞏 Parent/Guardian Sign: Date: / / Enrolment Agreement with Toi Ohomai Childcare Centre. I have read and understand the Toi Ohomai Childcare Centre Enrolment Policy. I agree to notify the Centre of changes to any information recorded on this enrolment form. I understand that once I state a “start date” the days and times approved are for example my child only and that fees are owed from that point. Also that fees are due for any days that my child is absent. I agree to bring and collect my child at the time specified so that the Centre can maintain staff/child ratios and understand penalty fees will be charged if I exceed these times. I understand the Centre closes at 5pm and I will be charged a prescription (late fee of $25 per quarter hour when booked times are exceeded I understand at least 1 week prior notice is required to make changes to my child’s booked hours. I will notify the Centre if anyone other than those listed, will pick up my child from the Centre and I understand my child must be kept in the Centre until such as asthma inhalerspermission is given. I have read and understand the Toi Ohomai Childcare Centre Payment of Fees Policy. I agree to accept all WINZ responsibilities and that I pay in full any amounts not paid by them for this service. I am aware that if I do not pay in accordance with the Centre Fee policy, epilepsy medication etc) used that my account will be placed with a debt collection agency. The Finance Department at Toi Ohomai Institute of Technology can use any person named on this document for the ongoing treatment purpose of a pre- diagnosed condition (such recovery of any outstanding debts, these persons are able to disclose my address and phone number. I agree to bring my child to the centre only if he/she is well. Diarrhoea and vomiting illnesses are very contagious. The centre requires, as asthmarecommended by the Ministry of Health, epilepsythat the child is free of symptoms for 48 hours before returning to the centre. I understand no photos or videos are to be taken in the Centres without Head Teachers permission. Children’s privacy must be protected, allergic reactionsNo photos are to be posted on any social media sites eg, diabetesFacebook, eczema etc) or; Non-prescription medicine (such as antihistamine syrupSnapchat or Instagram By enrolling my child, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used I agree to treat a specific conditional symptom provided by a parent for them being involved with the use of Information Communication Technology (ICT) as part of the learning environment. Children’s learning and assessment is recorded in an online digital format (Storypark) and I understand that my child’s image may appear in other children’s / group learning stories. Within the Centre's programme the children are regularly observed. In conjunction with Early Childhood Training providers, we assist with taking their students on practical placements. I give my permission for Students to undertake written observations, which do not identify my child, as part of their training. Yes 🞏 No 🞏 I give permission for teachers to keep examples of my child’s record of learning as evidence of their teaching practice for teacher registration purposes. Yes 🞏 No 🞏 Photograph/video material: I give consent for my child’s image to be used in Toi Ohomai Institute of Technology promotional and marketing use, including press advertisements, websites, posters and any other forms of advertising. Yes 🞏 No 🞏 I give my consent for my child/children to be taken on regular excursions around the Toi Ohomai Institute of Technology Campus and Windermere Park. I have read and understand the risk assessments for these regular excursions. Adult/child onlyratios for regular excursions will always be 1:3 for under 2s, 1:5 for 2-3 years, & 1:8 for over 3s. If your For special excursions teachers will provide you with a detailed letter requesting signed permission to take the child should require on the administering excursion. Yes 🞏 No 🞏 I understand that if I have any complaints regarding services I will direct these to the staff member concerned and then to the appropriate Manager. I understand that in the event of category (iii) medicationa civil disaster my child may be taken to an alternative safe location and will be looked after to the best of the centres ability, please complete until they can be collected. I have read and understood the Category (iii) Medication Plan which is included in your enrolment packMinistry of Health: Reducing food-related choking for babies and young children at early learning services. Parent/Guardian Signature: Date: / / I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finished.

Medicines. To A category (i) medicine is a non-prescription preparation (such as arnica cream for bruising, calendula for minor grazes, Urtica for 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. Sun screen is also applied daily as required during the summer months (with a baby sun sense screen for children in the infant and toddler centre) Name/s of specific category (i) medicines that can be filled in used on my child, provided by service: ▪ Arnica (for bruising) Yes □ No □ ▪ Urtica (for insect bite treatment) Yes □ No □ ▪ Calendula (for minor grazes) Yes □ No □ ▪ Sun Screen Yes □ No □ ▪ Zinc/Castor oil cream used as required after nappy change. Yes □ No □ N/A  Parent/Guardian Sign: Date: / / Children require an individual health plan if they require medication for an on-going condition such as asthma or eczema etc. Does your child requires medication as part of require an individual health plan? Tick One: If Yes, teachers will follow up to develop this plan with you Yes □ No □ Parent/Guardian Sign: Date: / / Enrolment Agreement with Toi Ohomai Childcare Centre. I have read and understand the Toi Ohomai Childcare Centre Enrolment Policy. I agree to notify the Centre of changes to any information recorded on this enrolment form. I understand that once I state a “start date” the days and times approved are for example my child only and that fees are owed from that point. Also that fees are due for any days that my child is absent. I agree to bring and collect my child at the time specified so that the Centre can maintain staff/child ratios and understand penalty fees will be charged if I exceed these times. I understand the Centre closes at 5pm and I will be charged a prescription (late fee of $25 per quarter hour when booked times are exceeded I understand at least 1 week prior notice is required to make changes to my child’s booked hours. I will notify the Centre if anyone other than those listed, will pick up my child from the Centre and I understand my child must be kept in the Centre until such as asthma inhalerspermission is given. I have read and understand the Toi Ohomai Childcare Centre Payment of Fees Policy. I agree to accept all WINZ responsibilities and that I pay in full any amounts not paid by them for this service. I am aware that if I do not pay in accordance with the Centre Fee policy, epilepsy medication etc) used that my account will be placed with a debt collection agency. The Finance Department at Toi Ohomai Institute of Technology can use any person named on this document for the ongoing treatment purpose of a pre- diagnosed condition (such recovery of any outstanding debts, these persons are able to disclose my address and phone number. I agree to bring my child to the centre only if he/she is well. Diarrhoea and vomiting illnesses are very contagious. The centre requires, as asthmarecommended by the Ministry of Health, epilepsythat the child is free of symptoms for 48 hours before returning to the centre. I understand no photos or videos are to be taken in the Centres without Head Teachers permission. Children’s privacy must be protected, allergic reactionsNo photos are to be posted on any social media sites eg, diabetesFacebook, eczema etc) or; Non-prescription medicine (such as antihistamine syrupSnapchat or Instagram By enrolling my child, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used I agree to treat a specific conditional symptom provided by a parent for them being involved with the use of Information Communication Technology (ICT) as part of the learning environment. Children’s learning and assessment is recorded in an online digital format (Storypark) and I understand that my child’s image may appear in other children’s / group learning stories. Within the Centre's programme the children are regularly observed. In conjunction with Early Childhood Training providers, we assist with taking their students on practical placements. I give my permission for Students to undertake written observations, which do not identify my child, as part of their training. Yes □ No □ I give permission for teachers to keep examples of my child’s record of learning as evidence of their teaching practice for teacher registration purposes. Yes □ No □ Photograph/video material: I give consent for my child’s image to be used in Toi Ohomai Institute of Technology promotional and marketing use, including press advertisements, websites, posters and any other forms of advertising. Yes □ No □ I give my consent for my child/children to be taken on supervised walks around the Toi Ohomai Institute of Technology and local area without any specific permission. Adult/child onlyratios for spontaneous outings will always be maintained at or above the minimum regulated ratios. If your For planned excursions teachers will provide you with a detailed letter requesting signed permission to take the child should require on the administering outing. Yes □ No □ I understand that if I have any complaints regarding services I will direct these to the staff member concerned and then to the appropriate Manager. I understand that in the event of category (iii) medicationa civil disaster my child may be taken to an alternative safe location and will be looked after to the best of the centres ability, please complete the Category (iii) Medication Plan which is included in your enrolment packuntil they can be collected. Parent/Guardian Signature: Date: / / I/we (please print first Policy Statement: Toi Ohomai Childcare Centre has a number of policies that set out the procedures that are in place for the care and last names) education of the children who attend. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and understand how you can have input into policy review. Parent Information: Please ensure you have read and agree with the Centre’s Administering Medication Policyinformation attached as it covers such things as policies, and fee details, subsidies that are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change available to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finishedyou.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If 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: ____ /____ / ____ 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: ____ /____ / ____  20 Hours ECE Attestation: Is your child should require receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the administering of category (iii) medicationabove, please complete 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 Category (iii) Medication Plan which 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 included enrolled at, about the information contained in your enrolment packthis box. Parent/Guardian Signature: _____________________________ Date: ____ /____ / / I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication ____  Dual Enrolment Declaration I hereby declare that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child is/is not enrolled at another early childhood institution at the same times that Ihe/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as she is practicable. I/we will seek management advice to clarify any enrolled at [insert name of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medicationsservice]. Parent/Guardian Signature: _____________________________ Date: ____ /____ / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finished.____  Optional Charges:

Medicines. To be filled in Children require an individual health plan if they require medication for an on-going condition such as asthma or eczema etc. Does your child requires medication as part of require an individual health plan? Tick One: If Yes, teachers will follow up to develop this plan with you Yes  No  Parent/Guardian Sign: Date: / / Enrolment Agreement with Toi Ohomai Childcare Centre. I have read and understand the Toi Ohomai Childcare Centre Enrolment Policy. I agree to notify the Centre of changes to any information recorded on this enrolment form. I understand that once I state a “start date” the days and times approved are for example my child only and that fees are owed from that point. Also that fees are due for any days that my child is absent. I agree to bring and collect my child at the time specified so that the Centre can maintain staff/child ratios and understand penalty fees will be charged if I exceed these times. I understand the Centre closes at 5pm and I will be charged a prescription (late fee of $25 per quarter hour when booked times are exceeded I understand at least 1 week prior notice is required to make changes to my child’s booked hours. I will notify the Centre if anyone other than those listed, will pick up my child from the Centre and I understand my child must be kept in the Centre until such as asthma inhalerspermission is given. I have read and understand the Toi Ohomai Childcare Centre Payment of Fees Policy. I agree to accept all WINZ responsibilities and that I pay in full any amounts not paid by them for this service. I am aware that if I do not pay in accordance with the Centre Fee policy, epilepsy medication etc) used that my account will be placed with a debt collection agency. The Finance Department at Toi Ohomai Institute of Technology can use any person named on this document for the ongoing treatment purpose of a pre- diagnosed condition (such recovery of any outstanding debts, these persons are able to disclose my address and phone number. I agree to bring my child to the centre only if he/she is well. Diarrhoea and vomiting illnesses are very contagious. The centre requires, as asthmarecommended by the Ministry of Health, epilepsythat the child is free of symptoms for 48 hours before returning to the centre. I understand no photos or videos are to be taken in the Centres without Head Teachers permission. Children’s privacy must be protected, allergic reactionsNo photos are to be posted on any social media sites eg, diabetesFacebook, eczema etc) or; Non-prescription medicine (such as antihistamine syrupSnapchat or Instagram By enrolling my child, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used I agree to treat a specific conditional symptom provided by a parent for them being involved with the use of Information Communication Technology (ICT) as part of the learning environment. Children’s learning and assessment is recorded in an online digital format (Storypark) and I understand that my child’s image may appear in other children’s / group learning stories. Within the Centre's programme the children are regularly observed. In conjunction with Early Childhood Training providers, we assist with taking their students on practical placements. I give my permission for Students to undertake written observations, which do not identify my child, as part of their training. Yes  No  I give permission for teachers to keep examples of my child’s record of learning as evidence of their teaching practice for teacher registration purposes. Yes  No  Photograph/video material: I give consent for my child’s image to be used in Toi Ohomai Institute of Technology promotional and marketing use, including press advertisements, websites, posters and any other forms of advertising. Yes  No  I give my consent for my child/children to be taken on supervised walks around the Toi Ohomai Institute of Technology and local area without any specific permission. Adult/child onlyratios for spontaneous outings will always be maintained at or above the minimum regulated ratios. If your For planned excursions teachers will provide you with a detailed letter requesting signed permission to take the child should require on the administering outing. Yes  No  I understand that if I have any complaints regarding services I will direct these to the staff member concerned and then to the appropriate Manager. I understand that in the event of category (iii) medicationa civil disaster my child may be taken to an alternative safe location and will be looked after to the best of the centres ability, please complete the Category (iii) Medication Plan which is included in your enrolment packuntil they can be collected. Parent/Guardian Signature: Date: / / I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finished.

Medicines. A category (i) medicine is a non-prescription preparation 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. Kaurilands Kindy uses Arnica Cream for bruises/sprains and Antihistamine for the relief from insect bites/stings Do you approve category (i) medicines to be used on your child? Tick One Yes o No o 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 a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If your child should require only Individual health plan completed and signed: Tick One Yes o No o Name of medicine: Method and dose of medicine: When does the administering of category medicine need to be taken: (iiiState time or specific symptoms) medication, please complete the Category (iii) Medication Plan which is included in your enrolment pack. Parent/Guardian Signature: Date: / / § Policy Statement: Kaurilands Kindergarten has a number of policies that set out the procedures that are in place for the care and education of the children who attend. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and understand how you can have input to policy review. § Enrolment Pack: Please ensure you have read the information in the parent handbook as it covers such things as fee details, subsidies that are available to you. § Privacy Statement: We are collecting personal information on this enrolment form for the purposes of providing early childhood education for your child. We will use and disclose your child’s information only in accordance with the Privacy Xxx 0000. Under that Act you have the right to access and request correction of any personal information we hold about you or your child. Details about your child’s identity will be shared with the Ministry of Education so that it can allocate a national student number for your child. This unique identifier will be used for research, statistics, funding and the measurement of educational outcomes. You can find more information about national student numbers at xxx.xxxxxx.xxxx.xx/xxxxxxx. • I/we (please print first give consent for my child to be examined and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. if necessary treated by a medical practitioner in my absence in case of emergency? Yes / No • I/we as give consent for my child to go outside when practicing the parentfire drill and to go for walks on the fields that surround the centre, visit to local schools (Xxxx Eden Intermediate, Kaurilands Primary) (Written permission is sought for all other trips e.g. public transport). Yes / No • While we ensure the information contained in the child’s portfolio respects confidentiality we do require you to give your permission for your child’s portfolio to be stored where others could view it. Yes / No • I/guardianwe give consent for photo’s/whānau member take full responsibility video to be taken of informing my child/ren for the Centre Manager or person purpose of responsibility of any change to assessments, planning and evaluations Yes / No • I/we give consent for my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may photos and learning stories to be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. displayed Yes / No • I/we have been informed sighted and made are aware that of the Centre staff are not trained Health Professionalspotential hazards within the kindergarten environment. Yes / No Signed: Date: • I/we take full responsibility in agree to become a member of the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to Kaurilands Kindergarten Incorporated and for my child that I/we have supplied to be enrolled at the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicablecentre. I/we will seek management advice to clarify any abide by the rules and constitution of the above written statements society and have read the conditions set down in the event I/we are uncertain parent’s information book. Signed: Date: I declare that all the information is true and correct to the best of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. my knowledge Parent/Guardian Signature: Date: / / On Behalf of Kaurilands Kindergarten, I declare that this form has been checked and all relevant sections have been completed. Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Change of Days/Times of Enrolment: Effective Date of Change: / / Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: Date: / / Do you give permission for your child Change of Days/Times of Enrolment: Effective Date of Change: / / Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: Date: / / To ensure that any potential hazards within the kindergarten environment are identified, documented and communicated to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake any persons who could be at risk from these hazards. Purpose Procedure • Asbestos in regular roof • Slipping on wet floors (especially in toilet area) • Lifting heavy equipment / children • Banging head - going through outside gate - an open cupboard doors in kitchen - going under outside stairs - garage shed • Tripping - on stairs - over equipment - stepping over playground edging • Hurting Back - raking bark - going under outside stairs • Sustaining injuries while helping children in carpentry area • Removing unwanted “waste” when preparing outside play area • Sunburn on a hot day • Hurting hands - Using stapler - Using warm glue gun - Garage shed door • Daily building health and annual celebrations within Centre such as Eastersafety checks are recorded • List of potential hazards are displayed • The building is owned by the Auckland Council and the kindergarten will ensure that the building has a current warrant of fitness and will keep a record of all building compliance schedule checks and maintenance checks. • The kindergarten will keep a hazard register. All hazards will be identified, Birthdayseliminated, Christmas for example? ❑ Yes ❑ No Please noteand isolated. If a hazard cannot be eliminated or isolated, if you have ticked “no” then your child will continue with the daily curricula activities up until effects of the celebration has finished.hazard must be minimised and managed. Word of mouth o Website o Facebook o Road Sign o Google Search o other

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an ongoing condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels . and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. 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: I am applying for a Work and Income Childcare Subsidy prior to my child starting at this Centre Yes / No If yes, I understand that even if eligible for a Work and Income Childcare Subsidy I am responsible for paying my fees in full until my subsidy is approved. I understand that I am responsible for any fees not covered by my subsidy. I am responsible for ensuring Work and Income is kept informed of any changes that may affect my subsidy. Any over-payment made by Work and Income will not be offset against any outstanding balance or paid out to the person responsible for payment of fees. I confirm that I have made a full application for a subsidy prior to my child starting at Pupuke Early Education Centre. Application date:  Enrolment Details: Pupuke Early Education Centre undertakes to deliver quality early childhood education and care to your child should in accordance with our Philosophy Statement, while ensuring the adults working in our service are healthy and similarly kept safe in accordance with our responsibilities under the Health & Safety at Work Act 2015. The service provider is required to eliminate and/or minimise risks to health and safety so far as is reasonably practicable. The term of this agreement, and your child's enrolment in our service, is from the Date of Enrolment to the Intended Date of Exit set out below. However, the continued enrolment of your child until the Intended Date of Exit (often the child’s 5th birthday) is not guaranteed. You may end your child's enrolment with us, and this agreement, at any time by notifying us in accordance with our enrolment policy. We require 2 weeks’ written notice. As set out, we may review your child's enrolment with us, and may end their enrolment, and this agreement before the administering Intended Date of category Exit: if you have not paid fees because of ongoing absences that have affected the funding we receive for your child (iiiif applicable) medicationif we consider that this would be in the best interests of the child, other children at the centre or the adults working in our service. We will always make reasonable efforts to work with you to resolve any issues that have arisen before ending your child's enrolment early for one of the reasons set out above. We will give you reasonable notice (to the extent possible, in the circumstances) if we decide to end your child's enrolment before the Intended Date of Exit. The enrolment of your child in our services is also dependent on the service continuing to be licensed, operational, and fully compliant with regulatory requirements including legal obligations in the Health and Safety at Work Act 2015. 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. Full days (7:30am-5:30pm) Part days (8:30am-3:30pm) Free morning session for 3-4-year-old (7:30-11:30am) up to 20 hours per week –Tui and Pukeko Rooms. Free afternoon session for 3-4-year-old (12:30-4:30pm) up to 20 hours per week –Pukeko Room only. 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: ____ /____ / ____  20 Hours ECE Attestation: Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick One Yes No Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the above, please complete 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 Category (iii) Medication Plan which 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 included enrolled at, about the information contained in your enrolment packthis box. Parent/Guardian Signature: _____________________________ Date: ____ /____ / / I/we (please print first and last names) have read and agree with ____  Optional Charges: The optional charge is for: Excursions outside the Centre’s Administering Medication Policy, and are fully aware and understand centre x.x. Xxxxx Xxxxxxx or Stardome. Cost to be advised at the procedure required for administering medicationstime. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility Special events held in the event of any allergic reaction centre e.g. We Can Keep Safe programme or reaction unknown puppet show. Costs are to be advised at the time. I understand that if I agree to pay for the prescribed medication has/optional charge, Pupuke Early Education Centre may cause enforce payment. The agreement to my pay the optional charge will last for: the time your child that I/we have supplied is attending Pupuke Early Education Centre. The rules about making changes to the staff agreement are: If you do not want your child to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify attend any of the above written statements above, please advise in writing at the event I/we are uncertain time of the contentevent. II understand that that optional charge is not compulsory and if I choose not to pay there will be no penalty, but my child will not attend the trip or special event. I agree/we do not agree (select one) to all of pay the Centre’s conditions and rules optional charge for administering prescribed medicationsthe activities/items specified in this enrolment agreement form. Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Statutory Holidays / Service Provider SignatureTerm Breaks This enrolment agreement is inclusive of school term breaks. Pupuke Early Education Centre is closed on statutory holidays; however, full fees are payable on these days. Note: Date: / / Health Services visit please inform us of any alteration in hours.  Dual Enrolment Declaration I hereby declare that my child is/is not enrolled at another early childhood institution at the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checkssame times that he/she is enrolled at Pupuke Early Education Centre. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Parent Declaration I declare that all the above information is true and correct to the best of my knowledge. Parent/Guardian Signature: _____________________________ Date: ____ /____ / Do ____ Effective Date of Change: ____ /____ / ____ Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____ Effective Date of Change: ____ /____ / ____ Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____ Effective Date of Change: ____ /____ / ____ Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____ Policy Statement: Our centre has several policies that set out the procedures that are in place for the care and education of the children who attend. We strongly urge you give permission for your child to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this centre and understand how you can have face paint applied? ❑ Yes ❑ No Do you give permission for your child input to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finishedpolicy review.

Medicines. To A category (i) medicine is a non-prescription preparation (such as arnica cream for bruising, calendula for minor grazes, Urtica for 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. Sun screen is also applied daily as required during the summer months (with a baby sun sense screen for children in the infant and toddler centre) Name/s of specific category (i) medicines that can be filled in used on my child, provided by service:  Arnica (for bruising) Yes □ No □  Urtica (for insect bite treatment) Yes □ No □  Calendula (for minor grazes) Yes □ No □  Sun Screen Yes □ No □  Zinc/Castor oil cream used as required after nappy change. Yes □ No □ N/A  Parent/Guardian Sign: Date: / / Children require an individual health plan if they require medication for an on-going condition such as asthma or eczema etc. Does your child requires medication as part of require an individual health plan? Tick One: If Yes, teachers will follow up to develop this plan with you Yes □ No □ Parent/Guardian Sign: Date: / / Enrolment Agreement with Toi Ohomai Childcare Centre. I have read and understand the Toi Ohomai Childcare Centre Enrolment Policy. I agree to notify the Centre of changes to any information recorded on this enrolment form. I understand that once I state a “start date” the days and times approved are for example my child only and that fees are owed from that point. Also that fees are due for any days that my child is absent. I agree to bring and collect my child at the time specified so that the Centre can maintain staff/child ratios and understand penalty fees will be charged if I exceed these times. I understand the Centre closes at 5pm and I will be charged a prescription (late fee of $25 per quarter hour when booked times are exceeded I understand at least 1 week prior notice is required to make changes to my child’s booked hours. I will notify the Centre if anyone other than those listed, will pick up my child from the Centre and I understand my child must be kept in the Centre until such as asthma inhalerspermission is given. I have read and understand the Toi Ohomai Childcare Centre Payment of Fees Policy. I agree to accept all WINZ responsibilities and that I pay in full any amounts not paid by them for this service. I am aware that if I do not pay in accordance with the Centre Fee policy, epilepsy medication etc) used that my account will be placed with a debt collection agency. The Finance Department at Toi Ohomai Institute of Technology can use any person named on this document for the ongoing treatment purpose of a pre- diagnosed condition (such recovery of any outstanding debts, these persons are able to disclose my address and phone number. I agree to bring my child to the centre only if he/she is well. Diarrhoea and vomiting illnesses are very contagious. The centre requires, as asthmarecommended by the Ministry of Health, epilepsythat the child is free of symptoms for 48 hours before returning to the centre. I understand no photos or videos are to be taken in the Centres without Head Teachers permission. Children’s privacy must be protected, allergic reactionsNo photos are to be posted on any social media sites eg, diabetesFacebook, eczema etc) or; Non-prescription medicine (such as antihistamine syrupSnapchat or Instagram By enrolling my child, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used I agree to treat a specific conditional symptom provided by a parent for them being involved with the use of Information Communication Technology (ICT) as part of the learning environment. Children’s learning and assessment is recorded in an online digital format (Storypark) and I understand that my child’s image may appear in other children’s / group learning stories. Within the Centre's programme the children are regularly observed. In conjunction with Early Childhood Training providers, we assist with taking their students on practical placements. I give my permission for Students to undertake written observations, which do not identify my child, as part of their training. Yes □ No □ I give permission for teachers to keep examples of my child’s record of learning as evidence of their teaching practice for teacher registration purposes. Yes □ No □ Photograph/video material: I give consent for my child’s image to be used in Toi Ohomai Institute of Technology promotional and marketing use, including press advertisements, websites, posters and any other forms of advertising. Yes □ No □ I give my consent for my child/children to be taken on supervised walks around the Toi Ohomai Institute of Technology and local area without any specific permission. Adult/child onlyratios for spontaneous outings will always be maintained at or above the minimum regulated ratios. If your For planned excursions teachers will provide you with a detailed letter requesting signed permission to take the child should require on the administering outing. Yes □ No □ I understand that if I have any complaints regarding services I will direct these to the staff member concerned and then to the appropriate Manager. I understand that in the event of category (iii) medicationa civil disaster my child may be taken to an alternative safe location and will be looked after to the best of the centres ability, please complete the Category (iii) Medication Plan which is included in your enrolment packuntil they can be collected. Parent/Guardian Signature: Date: / / I/we (please print first Policy Statement: Toi Ohomai Childcare Centre has a number of policies that set out the procedures that are in place for the care and last names) education of the children who attend. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and understand how you can have input into policy review. Parent Information: Please ensure you have read and agree with the Centre’s Administering Medication Policyinformation attached as it covers such things as policies, and fee details, subsidies that are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change available to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finishedyou.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (such as asthma inhalers, epilepsy medication etc) or non-prescription (such as antihistamine syrup, lanolin cream etc) medicine that is used for the ongoing treatment of a pre- pre-diagnosed condition (such as asthma, epilepsy, allergic reactionsreaction, diabetes, eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If your child A written authority from a parent given at enrolment as part of an individual health plan, or whenever there is a change, detailing what (name of medicine) how (method and dose) and when (time or specific symptoms/circumstances) the medicine should require be given. 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 administering of category medicine need to be taken? (iiiState time or specific symptoms) medication, please complete the Category (iii) Medication Plan which is included in your enrolment pack. Parent/Guardian Signature: Date: / / I/we Please give details of which primary school your child may attend and at what age. Please list any other siblings that attend Little Liberty Montessori or Xxxxxxx Xxxxxxxxxx (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training a sibling discount may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. apply): Do you give permission for your for? I acknowledge I have read & agreed to the 19. Excursion Policy Yes/No I acknowledge I have read & agreed to the 19d. Beyond the gate excursion Policy Yes/No My child to take part in regular walk to take part in ‘Beyond the Gate’ programme at Little Liberty Montessori, 0 Xxxxxx Xxxxxx, Xxxxxxxx. To access LLM via the internal gate or walking around via route A: Turn right out of Liberty car park onto 15th Ave, first right onto Devonport Road, first right onto Kowhai Street, using footpath (under the conditions stated in the excursion policy with the ration of 1:3) Yes / No My child to be checked photographed and/or videoed for the purposes of assessment, planning, evaluation, for Storypark and Montessori Compass? Yes / No My child to be observed by our visiting health servicesvisitors (e.g., students) and notes taken? ❑ Yes ❑ / No ParentMine and my child’s names and phone numbers to be given out to other parents or children within the school? Yes / No My child’s details to be loaded into an online secure portfolio in Storypark and Montessori Compass Yes / No I acknowledge I have read and understood the Reducing food and related choking for babies and young children at early learning services from The Ministry of Health Yes / No My child to attend Atrium sessions Yes / No My child’s photo to be used for the purposes of LLM& LM Facebook, marketing and parent group posts/Guardian Signature: Date: events Yes / / Do you give permission for your No My child to have face paint applied? ❑ Yes ❑ sunblock applied up to twice a day when required Yes/No Do Policies Liberty Montessori has several policies that set out the procedures in place for the care and education of your child. We strongly urge you give permission for to read these. The signing of this Enrolment Agreement indicates that you will abide by the policies of this service and understand how you can have input into policy review. You will find most of the information you need in the Parent Handbook, and the full set of policies are available to view in the parent area. Parent Information Book Please ensure that you have read the information in the enclosed Parent Handbook as it covers our practises in detail and outlines ways in which we can help you and your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with settle into the daily curricula activities up until the celebration has finishedLiberty Montessori family.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If your 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: / / I understand that in an emergency centre staff will apply immediate first aid as deemed necessary for the protection of my child should require while he/she is in their care. I understand that this includes calling the administering doctor named on the enrolment form, implementing the doctor’s instructions, calling an ambulance, and /or transporting my child to a hospital or clinic if unable to contract me to obtain my consent. I will pay for any costs incurred regarding medical cost or St Xxxx Ambulance costs. Parent/Guardian Signature: _ Date: / / I hereby declare that my child is/is not able to have their photo used for the promotion of category (iii) medication, please complete the Category (iii) Medication Plan which is included centre. Parent/Guardian Signature: Date: / _ / I understand that any photographic or video images I as a parent or legal guardian might take at centre events or outings will not be used inappropriately. I will not post images on social media without parental approval from the parents of any children who appear in your enrolment packthe image. Parent/Guardian Signature: Date: / / I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we I give permission for Centre staff my child to seek medical advice go on walks or short outings from an emergency health provider immediately the centre. These walks are recorded in the above instancedaily outings diary stating the number of children participating and who is accompanying them, as well as informing me/us as soon as is practicableper our Excursions Policy. I/we Staff: child ratio will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centrebe 1:3 for under 2’s conditions and rules 1:6 for administering prescribed medicationsover 2’s for spontaneous walks. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit Thank you for taking the Centre regularly time to carry out child wellbeing checks which consider these issues. We will happily respect your decision and you may include hearing feel free to change your decision at any time by updating this form. I declare that all the above information is true and vision, before school checks, dental and general health checkscorrect to the best of my knowledge. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission On behalf of Tiny Wonders Early Learning Centre I declare that this form has been checked and all relevant sections have been completed. Service Provider Signature: Date: / / Change of Days/Times of Enrolment: Effective Date of Change: / / Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 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 Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: Date: / / Individual Education Plan o I agree to my child being observed and photographed for your Individual Development Planning Enrolment Right o I understand that acceptance of enrolment of my child to have face paint applied? ❑ Yes ❑ No Do you give permission at the centre is in no way an assurance or guarantee of continued enrolment for your the time indicated or under the terms and condition effective at the time of enrolment. I declare that my child to partake is not enrolled in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with another early childhood service at the daily curricula activities up until the celebration has finishedsame times that they are enrolled at this centre.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If your child should require 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 administering of category medicine need to be taken: (iii) medication, please complete the Category (iii) Medication Plan which is included in your enrolment pack. State time or specific symptoms): Parent/Guardian Signature: Date: / / I/Permissions Required for the following: While some of the following questions may appear obvious, we as a preschool are required to obtain permission from caregivers for the following situations regarding your child. These are based on Ministry of Education Regulations. If you have any questions please come and see us. Every time you tick the box you give us permission to do the following for your child:  Small trips around the local neighbourhood. This is for very small trips – for example a walk to the shops down the road to see what is for sale or a walk to the bike shop down the road to have a look at the bikes. These will have minimum trip ratio of: o Two, three, four and five year olds – one adult for every five children. o Babies and one year olds - one adult for every three children.  Trip with permission (please print first this is for larger trips – we will still obtain a separate signature for these trips). These will have the standard trip ratio of: o Two, three, four and last namesfive year olds – one adult for every five children. o Babies and one year olds - one adult for every three children.  General photography for preschool so we can put photos into your child’s learning story’s folder  Photos for Students use (this means that our ECE student teachers can take photos of your child as part of their learning process while they are on section at our preschool) have read  Display of your child’s work on out walls Photos for publicity (these photos are - as always – flattering photos of your child. They will be used in:  Newsletters  Public newsletters  Our website  Facebook  Taking children on local walks  Provide details for school (about you child) For Health:  Basic First Aid  We need permission from you so that we can give your child pamol (which you need to provide) when required. Please note that medicine cannot be stored at preschool overnight and agree needs to go home with the Centre’s Administering Medication Policychild each night. Signed: Date: This enrolment agreement is inclusive of school term breaks and exclusive of Statutory Holidays. 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 are fully aware and understand the procedure required for administering medicationsthere must be no compulsory fees when a child is receiving 20 Hours ECE funding. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through Days Enrolled: Monday Tuesday Wednesday Thursday Friday Start Time Enrolled: Finish Time Enrolled: Total hours: 20 Hours ECE at this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. service Total hours: 20 Hours ECE at another service Total hours: Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finished.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an on-going condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels etc and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. 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: / / Are there any custodial arrangements concerning your child? If your child should require the administering of category (iii) medicationYES, please complete give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name:  Dual Enrolment Declaration I hereby declare that my child is/is not enrolled at another early childhood institution at the Category (iii) Medication Plan which same times that he/she is included in your enrolment packenrolled at Newstead Country Preschool. Parent/Guardian Signature: Date: / / I/we (please print first  Statutory Holidays / Term Breaks This enrolment agreement is inclusive of school term breaks and last names) have read exclusive of statutory days. Newstead Country Preschool operates for approximately 50 weeks per year. We are closed on statutory days and agree with for up to 2 weeks around Christmas. There are no fees charged while the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medicationscentre is closed. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we  I hereby give permission for Centre staff my child to seek medical advice from an emergency health provider immediately in be taken on short excursions outside the above instance, preschool perimeter security fence as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any part of the above written statements in the event I/we are uncertain of the contentnormal preschool programme. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which These excursions may include hearing trips to Newstead Walkway and vision, before school checks, dental and general health checks. Do you will be at or above minimum regulated ratios as appropriate YES / NO  I hereby give permission for your my child to be checked observed by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: students of early childhood education as part of their field training, and for staff to keep copies of selected learning stories as part of teacher registration, proof of competency YES / / Do you NO  I hereby give permission for any photos and video clips of my child at play to be used in child portfolios, teacher portfolios, videos, on Newstead Country Preschool’s website and displays which may be used to promote the early childhood education sector. YES / NO  Policy Statement: Newstead Country Preschool has a number of policies that set out the procedures that are in place for the care and education of the children who attend. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and understand how you can have input to policy review.  Parent Information Book: Please ensure you have read the information in the parent handbook as it covers such things as fee details, and ways in which we can help you and your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with settle into the daily curricula activities up until the celebration has finishedservice.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (for an ongoing condition such as asthma inhalers, epilepsy medication etc) used for the ongoing treatment of a pre- diagnosed condition (such as asthma, epilepsy, allergic reactions, diabetes, or eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels . and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. For staff: Individual health/action 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: I am applying for a Work and Income Childcare Subsidy prior to my child starting at this Centre Yes / No If yes, I understand that even if eligible for a Work and Income Childcare Subsidy I am responsible for paying my fees in full until my subsidy is approved. I understand that I am responsible for any fees not covered by my subsidy. I am responsible for ensuring Work and Income is kept informed of any changes that may affect my subsidy. Any over-payment made by Work and Income will not be offset against any outstanding balance or paid out to the person responsible for payment of fees. I confirm that I have made a full application for a subsidy prior to my child starting at Pupuke Early Education Centre. Application date:  Enrolment Details: Pupuke Early Education Centre undertakes to deliver quality early childhood education and care to your child should in accordance with our Philosophy Statement, while ensuring the adults working in our service are healthy and similarly kept safe in accordance with our responsibilities under the Health & Safety at Work Act 2015. The service provider is required to eliminate and/or minimise risks to health and safety so far as is reasonably practicable. The term of this agreement, and your child's enrolment in our service, is from the Date of Enrolment to the Intended Date of Exit set out below. However, the continued enrolment of your child until the Intended Date of Exit (often the child’s 5th birthday) is not guaranteed. You may end your child's enrolment with us, and this agreement, at any time by notifying us in accordance with our enrolment policy. We require 2 weeks written notice. As set out, we may review your child's enrolment with us, and may end their enrolment, and this agreement before the administering Intended Date of category Exit: if you have not paid fees because of ongoing absences that have affected the funding we receive for your child (iiiif applicable) medicationif we consider that this would be in the best interests of the child, other children at the centre or the adults working in our service. We will always make reasonable efforts to work with you to resolve any issues that have arisen before ending your child's enrolment early for one of the reasons set out above. We will give you reasonable notice (to the extent possible, in the circumstances) if we decide to end your child's enrolment before the Intended Date of Exit. The enrolment of your child in our services is also dependent on the service continuing to be licensed, operational, and fully compliant with regulatory requirements including legal obligations in the Health and Safety at Work Act 2015. 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. Full days (7:30am-5:30pm) Part days (8:30am-3:30pm) Free morning session for 3-4-year-old (7:30-11:30am) up to 20 hours per week –Tui and Pukeko Rooms. Free afternoon session for 3-4-year-old (12:30-4:30pm) up to 20 hours per week –Pukeko Room only. 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: ____ /____ / ____  20 Hours ECE Attestation: Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick One Yes No Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the above, please complete 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 Category (iii) Medication Plan which 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 included enrolled at, about the information contained in your enrolment packthis box. Parent/Guardian Signature: _____________________________ Date: ____ /____ / / I/we (please print first and last names) have read and agree with ____  Optional Charges: The optional charge is for: Excursions outside the Centre’s Administering Medication Policy, and are fully aware and understand centre x.x. Xxxxx Xxxxxxx or Stardome. Cost to be advised at the procedure required for administering medicationstime. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility Special events held in the event of any allergic reaction centre e.g. We Can Keep Safe programme or reaction unknown puppet show. Costs are to be advised at the time. I understand that if I agree to pay for the prescribed medication has/optional charge, Pupuke Early Education Centre may cause enforce payment. The agreement to my pay the optional charge will last for: the time your child that I/we have supplied is attending Pupuke Early Education Centre. The rules about making changes to the staff agreement are: If you do not want your child to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify attend any of the above written statements above, please advise in writing at the event I/we are uncertain time of the contentevent. II understand that that optional charge is not compulsory and if I choose not to pay there will be no penalty, but my child will not attend the trip or special event. I agree/we do not agree (select one) to all of pay the Centre’s conditions and rules optional charge for administering prescribed medicationsthe activities/items specified in this enrolment agreement form. Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Statutory Holidays / Service Provider SignatureTerm Breaks This enrolment agreement is inclusive of school term breaks. Pupuke Early Education Centre is closed on statutory holidays; however, full fees are payable on these days. Note: Date: / / Health Services visit please inform us of any alteration in hours.  Dual Enrolment Declaration I hereby declare that my child is/is not enrolled at another early childhood institution at the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checkssame times that he/she is enrolled at Pupuke Early Education Centre. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____  Parent Declaration I declare that all the above information is true and correct to the best of my knowledge. Parent/Guardian Signature: _____________________________ Date: ____ /____ / Do ____ Effective Date of Change: ____ /____ / ____ Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____ Effective Date of Change: ____ /____ / ____ Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____ Effective Date of Change: ____ /____ / ____ Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total 20 Hours ECE at this service 20 Hours ECE at another service Parent/Guardian Signature: _____________________________ Date: ____ /____ / ____ Policy Statement: Our centre has several policies that set out the procedures that are in place for the care and education of the children who attend. We strongly urge you give permission for your child to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this centre and understand how you can have face paint applied? ❑ Yes ❑ No Do you give permission for your child input to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finishedpolicy review.

Medicines. To be filled in Children require an individual health plan if they require medication for an on-going condition such as asthma or eczema etc. Does your child requires medication as part of require an individual health plan? Tick One: If Yes, teachers will follow up to develop this plan with you Yes □ No □ Parent/Guardian Sign: Date: / / Enrolment Agreement with Toi Ohomai Childcare Centre. I have read and understand the Toi Ohomai Childcare Centre Enrolment Policy. I agree to notify the Centre of changes to any information recorded on this enrolment form. I understand that once I state a “start date” the days and times approved are for example my child only and that fees are owed from that point. Also that fees are due for any days that my child is absent. I agree to bring and collect my child at the time specified so that the Centre can maintain staff/child ratios and understand penalty fees will be charged if I exceed these times. I understand the Centre closes at 5pm and I will be charged a prescription (late fee of $25 per quarter hour when booked times are exceeded I understand at least 1 week prior notice is required to make changes to my child’s booked hours. I will notify the Centre if anyone other than those listed, will pick up my child from the Centre and I understand my child must be kept in the Centre until such as asthma inhalerspermission is given. I have read and understand the Toi Ohomai Childcare Centre Payment of Fees Policy. I agree to accept all WINZ responsibilities and that I pay in full any amounts not paid by them for this service. I am aware that if I do not pay in accordance with the Centre Fee policy, epilepsy medication etc) used that my account will be placed with a debt collection agency. The Finance Department at Toi Ohomai Institute of Technology can use any person named on this document for the ongoing treatment purpose of a pre- diagnosed condition (such recovery of any outstanding debts, these persons are able to disclose my address and phone number. I agree to bring my child to the centre only if he/she is well. Diarrhoea and vomiting illnesses are very contagious. The centre requires, as asthmarecommended by the Ministry of Health, epilepsythat the child is free of symptoms for 48 hours before returning to the centre. I understand no photos or videos are to be taken in the Centres without Head Teachers permission. Children’s privacy must be protected, allergic reactionsNo photos are to be posted on any social media sites eg, diabetesFacebook, eczema etc) or; Non-prescription medicine (such as antihistamine syrupSnapchat or Instagram By enrolling my child, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used I agree to treat a specific conditional symptom provided by a parent for them being involved with the use of Information Communication Technology (ICT) as part of the learning environment. Children’s learning and assessment is recorded in an online digital format (Storypark) and I understand that my child’s image may appear in other children’s / group learning stories. Within the Centre's programme the children are regularly observed. In conjunction with Early Childhood Training providers, we assist with taking their students on practical placements. I give my permission for Students to undertake written observations, which do not identify my child, as part of their training. Yes □ No □ I give permission for teachers to keep examples of my child’s record of learning as evidence of their teaching practice for teacher registration purposes. Yes □ No □ Photograph/video material: I give consent for my child’s image to be used in Toi Ohomai Institute of Technology promotional and marketing use, including press advertisements, websites, posters and any other forms of advertising. Yes □ No □ I give my consent for my child/children to be taken on supervised walks around the Toi Ohomai Institute of Technology and local area without any specific permission. Adult/child onlyratios for spontaneous outings will always be maintained at or above the minimum regulated ratios. If your For planned excursions teachers will provide you with a detailed letter requesting signed permission to take the child should require on the administering outing. Yes □ No □ I understand that if I have any complaints regarding services I will direct these to the staff member concerned and then to the appropriate Manager. I understand that in the event of category (iii) medicationa civil disaster my child may be taken to an alternative safe location and will be looked after to the best of the centres ability, please complete the Category (iii) Medication Plan which is included in your enrolment packuntil they can be collected. Parent/Guardian Signature: Date: / / I/we (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. Do you give permission for your child to be checked by our visiting health services? ❑ Yes ❑ No Parent/Guardian Signature: Date: / / Do you give permission for your child to have face paint applied? ❑ Yes ❑ No Do you give permission for your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with the daily curricula activities up until the celebration has finished.

Medicines. To be filled in if your child requires medication as part of an individual health plan, for example a prescription (such as asthma inhalers, epilepsy medication etc) or non-prescription (such as antihistamine syrup, lanolin cream etc) medicine that is used for the ongoing treatment of a pre- pre-diagnosed condition (such as asthma, epilepsy, allergic reactionsreaction, diabetes, eczema etc) or; Non-prescription medicine (such as antihistamine syrup, lanolin cream, bonjela teething gels and steroid based eczema creams etc) that is used to treat a specific conditional symptom provided by a parent for the use of that child only. If your child A written authority from a parent given at enrolment as part of an individual health plan, or whenever there is a change, detailing what (name of medicine) how (method and dose) and when (time or specific symptoms/circumstances) the medicine should require be given. 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 administering of category medicine need to be taken? (iiiState time or specific symptoms) medication, please complete the Category (iii) Medication Plan which is included in your enrolment pack. Parent/Guardian Signature: Date: / / I/we Please give details of which primary school your child may attend and at what age. Please list any other siblings that attend Little Liberty Montessori or Xxxxxxx Xxxxxxxxxx (please print first and last names) have read and agree with the Centre’s Administering Medication Policy, and are fully aware and understand the procedure required for administering medications. I/we as the parent/guardian/whānau member take full responsibility of informing the Centre Manager or person of responsibility of any change to my child’s medical circumstances. I/we accept in some circumstances of administering medication that staff training a sibling discount may be required by an outside professional personnel or agency and I/we undertake to support the staff through this process. I/we have been informed and made aware that the Centre staff are not trained Health Professionals. I/we take full responsibility in the event of any allergic reaction or reaction unknown that the prescribed medication has/may cause to my child that I/we have supplied to the staff to administer. I/we give permission for Centre staff to seek medical advice from an emergency health provider immediately in the above instance, as well as informing me/us as soon as is practicable. I/we will seek management advice to clarify any of the above written statements in the event I/we are uncertain of the content. I/we agree to all of the Centre’s conditions and rules for administering prescribed medications. Parent/Guardian Signature: Date: / / Service Provider Signature: Date: / / Health Services visit the Centre regularly to carry out child wellbeing checks which may include hearing and vision, before school checks, dental and general health checks. apply): Do you give permission for? I acknowledge I have read & agreed to the Beyond the Gate, Excursion Policy and Risk Management for your Regular Walks Yes/No My child to take part in regular walk to take part in ‘Beyond the Gate’ programme at Little Liberty Montessori, 0 Xxxxxx Xxxxxx, Xxxxxxxx. To access LLM via the internal gate or walking around via route A: Turn right out of Liberty car park onto 15th Ave, first right onto Devonport Road, first right onto Kowhai Street, using footpath (under the conditions stated in the excursion policy with the ration of 1:3) Yes / No My child to be checked photographed and/or videoed for the purposes of assessment, planning, evaluation, for Storypark and Montessori Compass? Yes / No My child to be observed by our visiting health servicesvisitors (e.g., students) and notes taken? ❑ Yes ❑ / No ParentMine and my child’s names and phone numbers to be given out to other parents or children within the school? Yes / No My child’s details to be loaded into an online secure portfolio in Storypark and Montessori Compass Yes / No I acknowledge I have read and understood the Reducing food and related choking for babies and young children at early learning services from The Ministry of Health Yes / No My child to attend Atrium sessions Yes / No My child’s photo to be used for the purposes of LLM& LM Facebook, marketing and parent group posts/Guardian Signature: Date: events Yes / / Do you give permission for your No My child to have face paint applied? ❑ Yes ❑ sunblock applied up to twice a day when required Yes/No Do Policies Liberty Montessori has several policies that set out the procedures in place for the care and education of your child. We strongly urge you give permission for to read these. The signing of this Enrolment Agreement indicates that you will abide by the policies of this service and understand how you can have input into policy review. You will find most of the information you need in the Parent Handbook, and the full set of policies are available to view in the parent area. Parent Information Book Please ensure that you have read the information in the enclosed Parent Handbook as it covers our practises in detail and outlines ways in which we can help you and your child to partake in regular and annual celebrations within Centre such as Easter, Birthdays, Christmas for example? ❑ Yes ❑ No Please note, if you have ticked “no” then your child will continue with settle into the daily curricula activities up until the celebration has finishedLiberty Montessori family.