Child Care Center Enrollment Form

Child Care Center Enrollment Form

Running a day care center and wanted to offer an easier way to handle enrollments? If you're looking for a child care enrolment form template or an enrolment form template for child care, then this form may have everything you need. It's quite a long form with different sections. The form will ask for the child's details, the enrollment details, emergency contacts, child's health details, the parent/guardian's details, contact details of an authorized person. Use this child care enrollment form and customize the layout of the form fields based on your requirement. Form Preview
Child Care Center Enrollment Form Template | JotForm
  • Jack and Jill Enrolment Form

  • Childs Details

  • To qualify for the Childcare Rebate (CCR) and Childcare Benefit (CCB) you MUST provide your Customer Reference Number (CRN) below. If you do not have a CRN you need to register for Centrelink Online Services by contacting 136150.

  •  -  - Pick a Date
  • Enrolment Details

  •  -  - Pick a Date
  • Emergency Contact 1

  •  -
  • Emergency Contact 2

  •  -
  • Childs Health Details

  • Primary Parent/Guardian

  • To qualify for the Childcare Rebate (CCR) and Childcare Benefit (CCB) you MUST provide your Customer Reference Number (CRN) below. If you do not have a CRN you need to register for Centrelink Online Services by contacting 136150.

  •  -  - Pick a Date
  •  -
  •  -
  •  -
  • Parent/Guardian

  • To qualify for the Childcare Rebate (CCR) and Childcare Benefit (CCB) you MUST provide your Customer Reference Number (CRN) below. If you do not have a CRN you need to register for Centrelink Online Services by contacting 136150.

  •  -  - Pick a Date
  •  -
  •  -
  •  -
  • Authorised Person

  • To qualify for the Childcare Rebate (CCR) and Childcare Benefit (CCB) you MUST provide your Customer Reference Number (CRN) below. If you do not have a CRN you need to register for Centrelink Online Services by contacting 136150.

  •  -  - Pick a Date
  •  -
  •  -
  •  -
  • Consents

  • Declarations

  • Direct Debit Request and Credit Card Authority

  • Log on to www.myxplor.com to update your details online.

    A direct debit request or a Credit Card Authority allows us to debit directly to your financial institution or credit card account, respectively, for your childcare fee payment and any other amounts due to be paid by you under your agreement, as those amounts are due. If a due date for a direct debit falls on a weekend or public holiday, it will be processed on the next business day. Please contact your financial institution if you are uncertain when a debit will be processed.

    You can cancel your DDR or CCA by making a request in writing. We can vary these DDR and CCA terms in this agreement at any time on 5 working days notice. We will keep information about your financial account confidential, except to the extent necessary to resolve any claim you might have.

    If you give us a DDR you should (a) note that the direct debiting through bulk Electronic Clearing Systems not always available - please ensure your financial institution allows DDR on your account (b) confirm the account details by checking a recent statement from your financial institution; and (c) note that the DDR must be signed in the same way as the account signing instruction you have given. You are responsible for setting up your DRR.

    If you give us a CCA you must advise us of new credit card details prior to the expiry of the credit card otherwise, we are able to suspend your services until you do.

  • Should be Empty: