Enrolment | Small Fries

Child's Details

Your email*

Child's official surname or family name*

Child's official given name*

Child's official other names / middle names*

Please separate names with a comma

Surname / family name your child is known by / preferred name*

Given name your child is known by / preferred name*

Child's primary residential address*

Post Code*

Gender*

Child's date of birth*

Child's ethnic origin/s*

Iwi your child belongs to

Language/s spoken at home*

Do you attend a church?

For Statistical purposes only

Which church?

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 Act 2020. Under that Act you have the right to access and request correction of any personal information we hold about you or your child.

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

* 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.

Parents / Guardians

Parents / Guardians*

Add up to four parents / guardians below.

First names

Surname / Family name

Address

Post Code

Phone (Home)

Phone (Work)

Phone (Mobile)

Email

Relationship to child

Additional person/s who can pick up your child

Add up to two additional people who can pick up your child below.

First names

Surname / Family name

Address

Post Code

Phone (Home)

Phone (Work)

Phone (Mobile)

Email

Relationship to child

Are there any custodial arrangements concerning your child?*

Person/s who CANNOT pick up your child

Enter each person's name below

Emergency & Medical Details

Emergency Contacts*

These contacts will be contacted if parents/guardians are unable to be reached. At least one other contact must be provided outside of parent/guardian relationship.

First names

Surname / Family name

Address

Post Code

Phone (Home)

Phone (Work)

Phone (Mobile)

Email

Relationship to child/family

Child's doctor*

Name

Phone

Name of medical centre

Illness/allergies

Is your child up to date with immunisations?*

Name/s of specific category (i) medicines that can be used on my child, provided by service*

Arnica cream

Antiseptic cream/liquids

Sunblock

Nappy rash cream

Insect bit cream/ointment

Bonjela teething jel

None of the above

Medicine

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.

Do you approve category (i) medicines to be used on your child?*

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Parent / Guardian Signature*

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.

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Parent / Guardian Signature*

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.

Name of medicine

Method and dose of medicine

When does the medicine need to be taken?

State time or specific symptoms

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Parent / Guardian Signature*

Enrolment Details

Please enter your enrolment details below, making sure to select which days you'd like to be enrolled, if you'd like short or full days and if you're intending to utilise in the 20 Hours ECE (if applicable).

Please note: enrolment days/times and 20 Hours ECE will be confirmed in person.

Select your preferred Small Fries centre to enrol at*

Date of Enrolment*

Date of Entry*

Date of Exit

Days enrolled*

Monday

Tuesday

Wednesday

Thursday

Friday

Monday Day Length*

Tuesday Day Length*

Wednesday Day Length*

Thursday Day Length*

Friday Day Length*

20 Hours ECE (Children Aged 3 – 6yrs)

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. Fees Charged are for times outside of these hours.

Would you like to utilise the 20 Hours ECE?

Please note: we will work with you directly to confirm your 20 Hours ECE details.

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Parent / Guardian Signature*

Is your child receiving 20 Hours ECE at any other services?*

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Parent / Guardian Signature*

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.

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Parent / Guardian Signature*

I hereby declare that my child is/is not enrolled at another early childhood institution at the same times that he/she is enrolled at Small Fries Christian Childcare Centre.

Holidays & Information

Policy Statement: Small Fries Christian Childcare Centre has a number of policies that set out the procedures that are in place for the care and education of the children who attend. These can be found at reception, or given by request. We strongly urge you to read these and input into their review. The signing of this enrolment agreement form indicates that you will abide by the policies of this service.

Contract Termination: Either party (Small Fries Christian Childcare Centre, or the Parent/Guardian) may terminate this contract with two weeks written notice.

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Parent / Guardian Signature*

Excursions: By signing the below, I give permission for my child to take part in regular excursions (under the conditions stated in the service’s excursions policy). Regular excursions include walks over to the Windsor Park Church area (auditorium, café, café playground) and the connect rugby fields. Other excursions will be notified on individual permission forms.

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Parent / Guardian Signature*

Information sharing: I give permission to the Centre Manager or Team Leader to share necessary information with the Primary school my child will attend, for the purpose of providing better support to meet their transitional and learning needs. I understand I will be informed if extra help is needed for my child.

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Parent / Guardian Signature*

Photo/video: By signing the below I give permission for my child to be photographed for the purposes of assessment, planning, evaluation, displays within our Centre and promotional use, including our website, Storypark, and closed Facebook page. I also give permission for student teachers to photograph my child for course related assessment work as approved by the Centre Manager.

Statutory Holidays / Term Breaks

This enrolment agreement is inclusive of school term breaks.

Small Fries Christian Childcare Centre is closed on Statutory Holidays. Normal fees apply.

Small Fries Christian Childcare Centre has optional attendance for approximately two weeks over the Christmas and New Year holiday period. Fees only apply to those attending during this period. No fees are charged over this time for those who do not attend over this period.

Parent / Guardian Signature*

I declare that all the information filled out in this form is true and correct to the best of my knowledge.

Name

This field is for validation purposes and should be left unchanged.

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Become a Small Fry!

Enrolment Form

Already filled in a paper form?

Child's Details

Privacy Statement

Parents / Guardians

Emergency & Medical Details

Medicine

Category (i) Medicines

Category (ii) Medicines

Category (iii) Medicines

Enrolment Details

20 Hours ECE (Children Aged 3 – 6yrs)

Holidays & Information

Statutory Holidays / Term Breaks

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Outdated browser.

Become a Small Fry!

Enrolment Form

Already filled in a paper form?

Child's Details

Privacy Statement

Parents / Guardians

Emergency & Medical Details

Medicine

Category (i) Medicines

Category (ii) Medicines

Category (iii) Medicines

Enrolment Details

20 Hours ECE (Children Aged 3 – 6yrs)

Holidays & Information

Statutory Holidays / Term Breaks

Book a Visit

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Section End