BB Enrolment Form

BB Enrolment Form

Enrolment form for BB Form Preview
Blackmans Bay Enrolment Form
  • Blackmans Bay Enrolment Form

  •  /  / Pick a Date
  • Child Details

  •  /  / Pick a Date
  • Census Information

    The following information is used for census purposes only
  •   DAY AM PM
    Monday
    Tuesday
    Wednesday
    Thursday
    Friday
  •   BSC ASC
    Monday
    Tuesday
    Wednesday
    Thursday
    Friday
  •   Casual
    Other
  • Parent/Guardian 1

    Parent 1 is claiming CCB and account will be in this name
  •  /  / Pick a Date
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  • Parent/Guardian 2

    Parent 2 jointly and severally liable for payment of fees by the due date
  •  /  / Pick a Date
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  • Emergency Contacts and People Authorised to Collect Children

    Other than parents/guardians and must be over the age of 16 years
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  • Child's Medical Details

  •   Yes No
    Allergies/sensitivities
    Anaphylaxis
    Asthma
    Diabetes
    Other medical condition/s
  •   Yes No
    Does your child have any additional needs or disabilities including intellectual, sensory or physical impairment?
    Are there any special dietary requirements we need to be aware of?
    Does your child have any special requirements (ie cultural, religious)?
  •   Yes No
    Is your child’s immunisation up to date?
  • If you answered YES, please provide statement of immunisation for sighting.

    If you answered NO:

    • I have chosen not to have my child immunised;
    • I have provided a statutory declaration in relation to my child’s immunisation status; and
    • I am aware that my child will be excluded during any outbreak of a vaccine preventable disease.
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  • Family Registration Consents

  • Should be Empty: