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Choose a programme:
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Programme:
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Child's details
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First name
Please write in “Capital letter, small letters” eg Hemi. This name will appear on the register. No second names.
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Surname
Please write as “Capital letter, small letters” eg Smith.
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Date of birth
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Gender
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School name
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Child's class
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Child's Year at school
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Ethnicity
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If Other, please state:
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Address
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Phone (home)
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Parents separated?
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If Yes: sole or shared custody?
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If Shared Custody please detail arrangements
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Child's doctor's name
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Child's doctor's phone
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Details of Key Parent or Caregiver #1
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Please list details for at least one parent or caregiver below.
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1. Name
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1. Relationship to child
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1. Home phone
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1. Mobile
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1. Work phone
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1. Employer's company name
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1. Employer's company address
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1. Preferred email address
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1. Alternate email address
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Details of Key Parent or Caregiver #2
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2. Name
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2. Relationship to child
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2. Home phone
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2. Mobile
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2. Work phone
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2. Employer's company name
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2. Employer's company address
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2. Preferred email address
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2. Alternate email address
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Other people authorised to collect your child from the programme:
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1. Name
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1. Relationship to child
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1. Mobile
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2. Name
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2. Relationship to child
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2. Mobile
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3. Name
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3. Relationship to child
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3. Mobile
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Medical conditions:
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Does your child have any medical issues? e.g. ADHD Medication, asthma, allergies
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Cultural / religious or other needs:
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Are there any cultural, religious or other needs we should know about? e.g. dietary or otherwise
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Extra-curricular activities:
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Current extra-curricular activities that staff may be required to collect your child from within School grounds. Please detail start and finish times and whereabouts of activity: eg Kelly Sport, Wednesday 3:15-4:30pm.
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Attendance:
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Please select the sessions required. (For casual attendance see below)
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Monday:
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Tuesday:
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Wednesday:
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Thursday:
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Friday:
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Start date:
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Are you applying for the OSCAR subsidy?
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Casual attendance only: Dates of attendance if known:
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Civil Emergency contacts:
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WE WILL ALWAYS CONTACT PARENTS/CAREGIVERS FIRST.
If we need to contact you, but you cannot be reached, we may need to contact your alternative emergency contacts. Please provide the names of 2 adults who you agree can be contacted in an emergency if you are not available. NB: We would prefer that these contacts live within one kilometre of the OSCAR House programme and they are available during the hours of OSCAR programme operation.
By listing these emergency contacts, you authorise OSCAR House to contact the nominated people in the event of a civil defence emergency.
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1. Name (Not Parent/Caregiver)
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1. Relationship to child
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1. Mobile
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1. Work phone
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1. Home phone
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1. Home address (required)
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2. Name (Not Parent/Caregiver)
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2. Relationship to child
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2. Mobile
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2. Work phone
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2. Home phone
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2. Home address (required)
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Parent Contract:
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Parent/caregiver name
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