Children'S Services Enrolment Form Part B: Family Form printable pdf download

Children'S Services Enrolment Form Part B: Family Form

Children’s Services Enrolment Form

Part B: Family Form





Please tick

if you need help with this form.

Please return your completed enrolment form to the service

Primary Adult

Second Adult

Name:

Date of Birth:

Address:

Relationship to

child:

Phone:

Home:

Phone:

Home:

Work:

Mobile:

Email:

Occupation/Study:

Country of Birth:

Language Spoken:

CRN Number:

Declared Closures/Preferred Contact

In case of a declared emergency/emergency evacuation, your child’s service being closed, an incident or

illness involving your child or in the event that staff are not available, Council will attempt to notify

parents/guardians as soon as possible.

 Primary Adult or

 Second Adult

Who would you like us to contact first?

( please tick)

What is your preferred method of notification for non-urgent communication?

 SMS to your preferred mobile

 Telephone call to your land line

 Email

Family Medical Information

Doctor’s Name/Medical Service:

__________________________________________________________

Address:

__________________________________________________________

Phone Number:

______________________

Medicare Number (if available)

__________________________________________________________

Family Dentist

Dentist Name:

______________________________________________________

Address:

__________________________________________________________

Phone Number

_______________________

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Children'S Services Enrolment Form Part B: Family Form

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