Please fill in all the fields

Please remember to sign the back of the form

Childs name

Anyone legally not allowed access:

(If this person is a legal guardian-proof must be given)

Date of birth

Age

Year at school Health conditions/other relevant information Description of medication and dosage Family doctor Doctors ph number

Class rm

Names of people allowed to collect child(ren):

Ethnicity(optional)

Gender

M/F

Childs name

Date of birth

Age

Year at school

Class rm

Rocket
Afterschool Programme 2013
Based at Christchurch East School Run by Newell House Trust In association with Oxford Terrace Baptist Church WINZ subsidies available

Ethnicity(optional)

Gender

M/F

Childs name

Date of birth

Age

Permanent enrolment $12/day/child m t w th f Casual enrolment $13/day/child Total weekly fees Start date Applying for WINZ subsidy?
Yes/No

Year at school

Class rm

Ethnicity(optional)

Gender

M/F

Caregiver(s)

Relationship

Street address

Suburb

Mobile

-Only available for enrolments for 2 or more afternoons -1 week deposit is required in advance -Proof of completed WINZ application is required before the end of the first week.

www.otbc.org.nz

Phone (wk)

Phone (hm)

Date AP will start Amount of deposit paid on enrolment Do you want your child(ren) to do homework each afternoon? Please provide details. How did you hear about us? Any other information: I need information on Holiday care Yes/No

Email

These details must be different to caregiver details

Emergency contact (1)

Relationship to child

If you have any questions about Rocket, or wish to see the Programme or policies, please dont hesitate to ask the Manager or another member of Staff.

Phone

Emergency contact (2)

Relationship to child

Phone

Manager: Emma Tovey emma@otbc.org.nz 0277806629

 I understand that any changes to my child/rens attendance for Rocket After school care, ideally needs to be communicated to the Manager by phone email or text by 2.30pm. I agree to my child/ren travelling by vans for any Rocket activities on the term plan. I understand that Rocket will be responsible for my child/ren from the time they are sighted by the Supervisor at the school or on arrival at Rocket until they are signed out on the roll. I understand anyone picking up my child/ren including myself may be asked for photo I.D at any time. I agree to my child/ren watching PG rated movies if they are deemed as age-appropriate by Rocket. I agree to Rocket Staff administering the medication as detailed by myself in the Medical Action Plan and Administration of Medication form which I have completed in full and signed. I agree to Staff seeking medical assistance for my child/ren as necessary. Any cost incurred in obtaining such aid will be met by me. I agree to photos and videos of my child/ren taken at Rocket being used for Rocket publicity. I agree to my child/ren being disciplined by the Supervisor, according to the discipline procedure. I agree for Rocket Staff to apply sun block as needed throughout the day. I give permission for my child/ren to go on local walks with Rocket. I understand there will be a late fee charged to my account if I collect my child/ren later than 5.30pm of $10. I agree to constantly pay the fees one week in advance. I agree that if I fail to pay my account and Rocket has to involve a debt collection agency, the collection costs incurred will be added to the total of my account. I am aware that I will be charged for the days my child is booked in for, even if my child is absent. I agree to accept all WINZ responsibilities and that I pay in full any amounts not paid by them for this service and until WINZ payments begin. I understand that every year I need to re-enrol my child/ren. I understand that Rocket has the right to suspend or terminate my enrolment due to lack of payment or due to unacceptable behaviour by my child/ren. I understand that I will be contacted to collect my child/ren if they become sick during Rocket. Im responsible for notifying Rocket of any changes in circumstance or contact/medical details. All care will be taken to provide supervision of children attending Rocket in accordance with the Programme policies and procedures. I acknowledge however, in signing this form that neither the Staff nor management of Rocket will be liable for any loss or damage (by way of accident, injury, theft or otherwise) arising out of attendance at Rocket. The Privacy Act 1993. Rocket wishes to collect personal details for the purpose of Programme registration and supervision. This information will be accessible to Rocket Staff and is intended for Programme Supervisors. You have the right to access and check any details you have supplied. This information is not required by law, however, if refused, it may be necessary to decline your enrolment. The information on this form may be viewed by Child Youth and Family. I have read and agree to all the information on this form. I have filled in all fields on the enrolment form. Date: / Signed (Parent/ Caregiver) /

Bank account 01-0798-0083959-00 (Please include name) Enrolment Enrolment is finalised upon completion of an enrolment form, the signing of this brochure and payment of one weeks fees in advance. Please inform Rocket Staff of any relevant changes to your enrolment details. It is crucial we have up to date info. Casual enrolments We have casual enrolments available at $13.00 per day. Requests for a space can be made by text, phone call or email to Emma the Manager. Spaces may or may not be available depending on the number of children already enrolled on that day. Afternoon tea This is provided each afternoon. Absences Please inform us by 2.30pm if your child will not be attending. Fees will be charged for enrolled days, regardless of attendance. If we have not been informed of an absence, and cannot get in touch with you-we are required to contact the police. There will be no charge for public holidays. Collecting your child If a person arrives to collect your child whose name is not on the enrolment form, we are obliged (for your childs safety) to keep your child in our care until you have been located for consent. To save embarrassment for all concerned we would appreciate prior notification from you on this matter. Please remember Rocket closes at 5.30pm. A late fee of $10.00 will be charged if the child is collected after this time. If your child is not collected by 6.00pm, they will be taken to the central police station. Signing your child out Each day when you collect your child, it is essential that you sign your child out of the daily roll book. The Supervisor will show you where this is. We need to know that your child was collected safely. Fees Fees are our major source of income. To operate efficiently we require that fees be paid in advance weekly by automatic payment. If this is not possible, please talk with the Manager (Emma Tovey). Receipts will be given once a term, unless otherwise asked for. You must pay for all enrolled days. Casual days that are booked and then cancelled must be paid for. This is because we buy food and organise staff in advance. Management Management reserves the right to terminate your childs place in Rocket as from the Monday of the week following the non-payment of fees. Sickness You may be contacted to collect your child early if they become unwell. Please do not send your child to the programme if they have been vomiting or had diarrhoea in the last 24 hours. Notices will be posted at Rocket for parents in the event of infectious diseases having been present at Rocket. Behaviour If we feel we are unable to keep your child (or other children) safe due to your childs behaviour, we reserve the right to contact you for early collection. Complaints A complaints procedure can be found at the sign in desk.

Office use: Proof of WINZ application Date completed Deposit received Parent talked through enrolment form

Client number..