Enrollement Form

  • Child Details
  • Parent Details
  • Health
  • Enrolment Details
  • Declaration

Child Details

New Zealand birth certificate
Foreign birth certificate
New Zealand passport
Foreign passport
Other
Male
Female

Privacy Statement

All early childhood services must meet their responsibilities under the Privacy Act 2020, which include providing a Privacy statement on enrolment agreements which meets the requirements of that Act (see Principle 3 - Collection of information from subject). Additionally, all Privacy statements must include the exact wording below:

Personal information about your child collected on this enrolment form is shared with the Ministry of Education who store it securely and treat it in accordance with the Privacy Act 2020.

Information is disclosed to the Ministry:

  • for funding allocation purposes
  • for monitoring purposes
  • to allow the assignment of a National Student Number* to your child, and
  • to allow the Minister or Secretary of Education to exercise any of their other powers or responsibilities under the Education and Training Act 2020, and as permitted by Privacy Principles 10 and 11.

Completed forms may also be viewed by Ministry officials on request for the purposes of monitoring and licensing.

* A National Student Number is a unique identifier for your child within the education system. You can find more information about National Student Numbers and what they are used for at National Student Number (NSN) » NZQA

Early childhood services can find out more information about NSN assignment – including acceptable identity verification documents – at: National Student Numbers (NSN) – Education in New Zealand

The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, which if received, should be securely destroyed once verified.

PARENT / GUARDIANS

1. Given names:
2. Given names:

Additional Person/s who can pick up your child

1. Given names:
2. Given names:

EMERGENCY CONTACTS

Add emergency contact(s) other than Parent/Guardian - (Also able to pick up your child)

1. Given names:
2. Given names:
Custodial Statement:
Person/s who cannot pick up your child:

Please advise us immediately if there are any changes to custodial arrangements concerning your child, or to the persons who cannot pick up your child, including because of court orders.

HEALTH

Child's Doctor
Child’s Health:
Medicines

Category (i) Medicines

A category (i) medicine is a non-prescription preparation (such as arnica cream, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet.

Note: The service must provide specific information about the category (i) preparations that will be used.

Name/s of specific category (i) medicines that can be used on my child:

Category (ii) Medicines

Category (ii) medicines are prescription (such as antibiotics, eye/ear drops etc) or non-prescription (such as paracetamol liquid, cough syrup etc) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service.

I acknowledge that written authority from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given.

Category (iii) Medicines

To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only.

About your child

Our centre is committed to inclusive education, as per Te Whāriki and the National Education and Learning Priorities (NELP), in particular with reference to Objective 1: Learners at the centre and Objective 2: Barrier free access. This commitment includes working with families and whānau to find ways to reduce barriers to education for disabled learners and those with learning support needs.

If your child has an illness or condition, what are the implications or actions to be taken in relation to the child’s illness or condition. For example, does the child’s illness or condition require an individual health plan?

For this purpose, please indicate whether you would like to book a meeting to share any health, wellbeing, and/or education and child development information with the centre. This will assist the centre to help your child settle in as well as possible and receive the appropriate health care.

ENROLLEMENT DETAILS

Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding.

Days Enrolled: Monday Tuesday Wednesday Thursday Friday Total Hours:
Times Enrolled:

For 20 Hours ECE fill out boxes below with the hours attested e.g. 6 hours

Monday Tuesday Wednesday Thursday Friday Total Hours:
20 Hours ECE at this service
Monday Tuesday Wednesday Thursday Friday Total Hours:
20 Hours ECE at another service

20 Hours ECE Attestation:

If yes to either of the both 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.
Dual Enrolment Declaration

I hereby declare that my child is/is not enrolled at another early childhood institution at the same times that he/she is enrolled at Minimee Early Childhood Adventure.

Family Boost Rebate Scheme
Work and Income Childcare Subsidy
  • 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 [centre name].
Absences

You must advise us of any absences, whether planned or unplanned, including because your child is sick or has an injury, will be away for holidays (outside of any holidays where the centre is closed), or any other reason. [Please refer to our absence policy]. (ECC Note: this assumes your centre has an absence policy).`

Continuous or frequent absences impact on the funding that we get from the Ministry of Education.

  • A continuous absence is when an enrolled child is absent for a period of more than three weeks.
  • A frequent absence is when an enrolled child's actual attendance in a month does not match their enrolled hours for at least half of that month.

As set out in this agreement and our enrolment policy, we may review this enrolment agreement with you because of continuous or frequent absences. We may ask you to reconfirm your child's hours or enrolment or change the hours of enrolment. In some cases, we may end your child's enrolment with us early (before the Intended Date of Exit) because of continuous or frequent absences. (ECC Note: Centres using this enrolment template should ensure that their enrolment policy is included with this information and is consistent with this section of the enrolment agreement).

We will always make reasonable efforts to work with you to resolve any ongoing absence issues, and will give you reasonable notice (to the extent possible, in the circumstances) if we decide to end your child's enrolment early.

Alternatively, we may (with your agreement) charge you an additional fee to help cover the costs of any reduction in our funding due to continuous or frequent absences, as set out in our Fees Schedule. The charge for Sustained Absences is [$80] per day, and is charged in addition to the usual fees you pay for your child's enrolment at our centre (including for those days on which your child was absent).

ECC Note: Keep your Sustained Absences charge simple and consider whether to make it the same as the standard daily charge or not, taking into account that the place could have been filled by a child who actually attended.

Statutory Holidays / Term Breaks

This enrolment agreement is inclusive of school term breaks. Minimee is NOT open on statutory holidays.

Required Information for Licensing Purposes

Excursions: I give permission for my child to take part in regular excursions (under the conditions stated in the service’s excursions policy).

Spontaneous/Regular excursion Location List

  • Monarch Playground (68 Moore Street, Hillcrest)
  • Kauri Glen Park (Entrance on Pupuke road)
  • Around the block
Other information
  • Policy Statement:Minimee Early Childhood Adventure 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.
  • Policy booklet is available at the office and can also be emailed upon request. Please take the time to read policies.
  • Parent Information Book:Please ensure you have read the information in the parent handbook as it covers such things as medical information and ways in which we can help you and your child settle into the service.
  • Fees Schedule and Policy:I have read the fees schedule and terms and conditions and agree to abide by the policy.

DECLARATION

Statutory Holidays / Term Breaks

I declare that all the above information is true and correct to the best of my knowledge.

Service Declaration

On behalf of Minimee Early Childhood Adventure I declare that this form has been checked and all relevant sections have been completed.