Enrollment Form

    CHILD’S PERSONAL DETAILS












    Gender : MaleFemale


    CHILD’S EATING DETAILS


    Is the child on any special diet?
    YesNo
    If yes, please indicate details below.

    Does your child have any food allergies?
    YesNo
    If yes, please indicate details below.

    Would you allow us to post a photo of your child to alert all staff of his/her allergy?

    YesNo

    CHILD’S SLEEPING DETAILS


    Does your child take a nap? YesNo
    How many times a day?
    How Long?

    CHILD’S TOILETING DETAILS


    Does your child use diapers? YesNo
    Does your child use a potty or the toilet?

    CHILD’S DEVELOPMENT DETAILS


    Do you have any concerns about your child’s development?
    YesNo

    Explain :
    Has your child been in child care before?
    YesNo
    Is your child comfortable in group situations?
    YesNo
    Is there anything we should know about your child’s play with other children, by themselves, any concerns
    What kid’s of activities does your child enjoy?
    Are there activities your child avoids?
    How would you describe your child’s temperament and personality?
    Does your child have siblings?
    YesNo

    CHILD’S HEALTH DETAILS


    Has your child received all scheduled immunizations? YesNo
    If no, your child will need to be excluded from the site during outbreaks of some infectious diseases.

    PARENT/GUARDIAN DETAILS

    PARENT 1/GUARDIAN 1 DETAILS
    (enrolling parent/guardian)

    Mr./Mrs./Ms./Other:
    Family Name:
    Given Names:
    Gender
    Relationship to child:
    Employment status:
    Work location:
    Work phone number:
    Mobile number:
    Nationality:
    Does parent 1 speak a language other than English?:
    Does this parent require an interpreter?
    Email address:
    Signature of enrolling parent/guardian:
    Date:

    PARENT/GUARDIAN DETAILS

    Mailing address:
    Residential address:

    OTHER PARENT/GUARDIAN NOT RESIDING AT SAME ADDRESS AS CHILD


    Mr./Mrs./Ms./Other:
    Given Names:
    Relationship to child:
    Work location:
    Work phone number:
    Email address:
    Family Name:
    Gender

    PERSONS AUTHORISED TO COLLECT CHILD

    1.
    Full Names:
    Relationship to child:

    2.
    Full Names:
    Relationship to child:

    EMERGENCY CONTACTS IF PARENTS/GUARDIANS CANNOT BE CONTACTED

    3.
    Full Names:
    Relationship to child:

    4.
    Full Names:
    Relationship to child:

    DETAILS OF CHILD’S DOCTOR


    Full Names:
    Relationship to child:

    DETAILS OF CHILD’S DOCTOR

    No.
    Child’s Name
    Date Of Birth
    Attends This Center?

    ANY OTHER INFORMATION/COMMENTS

    ANY OTHER INFORMATION/COMMENTS

    I give permission for my child to be photographed. Photo’s may appear on the RISA Facebook page, Newsletter, posters etc. My child may appear in group photos which may be included in printed media.

    I give permission for my child to receive first aid in the case of an emergency and/or for them to be taken to RISA’s nearest hospital.