Fun Space Enrolment Form
Please complete the below information to enrol your child into the program.

Reach out at hello@funspace.com.au if you have any questions!
Child's Details
First Name
Your answer
Last Name
Your answer
DOB
MM
/
DD
/
YYYY
Gender
Home Address
Your answer
Any special circumstances?
Your answer
Health Information
Child's Medicare Number & Expiry
Your answer
Medical Practitioner's Name & Contact Details
Your answer
Questions
Yes
No
Does your child have a Health Record?
Has your child been immunised?
Is your child receiving regular prescribed medicine?
Does your child have any medical allergies?
Has your child be diagnosed or at risk of anaphylaxis?
Does your child have an epipen or anipen?
Does your child have any other health conditions?
Does your child have any dietary requirements?
Does your child have asthma?
Primary Carer's Details
First Name
Your answer
Last Name
Your answer
Relationship
Your answer
Contact Number
Your answer
Email
Your answer
Home Address (if different to the child's)
Your answer
Employer
Your answer
Work Address
Your answer
Questions
No
I consent to be an emergency contact.
I consent to be an authorised nominee to collect this child.
I consent to be an authorised nominee to make medical decisions on behalf of this child.
I consent to be an authorised nominee for this child's incursions and excursions.
Please nominate any other person(s) that may be dropping off or collecting the child
Your answer
Any other information we need to know?
Your answer
Consents
Yes
No
Do you consent for the service to seek medical treatment for your child from a medical practitioner, hospital or ambulance in the event you cannot be contacted?
Do you consent for your child to be transported by an ambulance service?
Do you consent for the service to take photographs and videos of your child during normal activities and excursions?
Do you consent to provide your child with a sun safe hat for outdoor activities?
I give permission for educators with current first aid to administer paracetamol in an emergency in the correct dosage for the age of my child. Administration of this medication will only be given in the event of a parent being un-contactable in consultation with the director or nominated supervisor.
Do you consent for the service to apply sunscreen for your child before outdoor activities and excursions?
Do you consent for the service to administer Ventolin or Epi-pen to your child in case of emergency?
I agree to accurately record the time of arrival and departure of my child from the service in accordance with the service requirements.
I give permission for educators and school teachers/principals to share information about my child in relation to their care and wellbeing.
I give permission for my child to use/view technology (i.e. Tablet, TV, iPod)
I give permission for my child to participate in regular local excursions from the service by foot.
I agree to notify the service when my child is to be collected by any person other than those listed on this enrolment form in accordance with the services policies and procedures.
Do you require a PEEP for your child?
Declarations
Yes
No
Do you agree to collect or make arrangement for the collection of your child if they become unwell at the service?
Do you agree to keep your child away from the service if they display any symptom that could be considered contagious?
I give permission for my child to participate in regular evacuation drills or an actual evacuation when necessary. I understand that my child will be relocated from the service under the supervision of their educator and service team member to a safety zone for evacuation purposes.
I am aware that I am required to pay my service fees in accordance with their policies and non-payment could result in cancellation of my child’s enrolment and recovery action may be undertaken at my expense.
I declare that I am the applicant named in the form and that all information and documents provided as part of my application are true and correct.
Submit
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