Webform

Child Care Agreement and Child Care Subsidy (CCS)

Definitions
Complying Written Arrangement	CWA	A CWA is an enrolment type used for families wishing to claim CCS now or in the future
Relevant Arrangement	RA	An RA is an enrolment type used for families not wishing to claim CCS
Additional Child Care Subsidy ACCS	ACCS	A CCS is used when a child care provider identifies that a child is at risk of serious abuse or neglect but there is no individual identified to pay the child care fees

Learning Centre Location

Carinya Early Learning Centre

Moe Early Learning Centre

Traralgon Early Learning Centre

Family Day Care

School Holiday Program

Enrolling Parent/Guardian details

Enrolling Parent Guardian WWC No.

Enrolling Parent/Guardian CRN

Enrolling Parent/Guardian first name

Enrolling Parent/Guardian last name

Enrolling Parent/Guardian Date of Birth (Year-Month-Date)

Enrolling Parent/Guardian Home Phone

Enrolling Parent/Guardian Mobile Number

Unit Number

Street Address

Suburb/Town

Postcode

Enrolling Parent/Guardian Email

Enrolling Parent/Guardian Employment Status

Full time

Part Time

Casual

Unemployed

Student

Enrolling Parent/Guardian Employer

Enrolling Parent/Guardian Occupation

Enrolling Parent/Guardian Work Phone

Is English your first language?

Yes

Other Language

Parent/Guardian WWC No.

Parent/Guardian WWC No.
	Parent/Guardian WWC No.	Item weight

more items

Parent/Guardian details

Parent/Guardian CRN

Enrolling Parent/Guardian first name

Enrolling Parent/Guardian last name

Parent/Guardian Date of Birth

Parent/Guardian Home Phone

Parent/Guardian Mobile Number

Unit Number

Street Address

Suburb/Town

Postcode

Parent/Guardian Email

Parent/Guardian Employment Status

Full time

Part Time

Casual

Unemployed

Student

Parent/Guardian Occupation

Parent/Guardian Employer

Parent/Guardian Work Phone

Is English your first language?

Yes

Other Language

Emergency Contacts

Emergency Contact first name

Emergency Contact last name

Emergency Contact 1 Relationship

Unit Number

Street Address

Suburb/Town

Postcode

Emergency Contact 1 Home Phone

Emergency Contact 1 Mobile Phone

Emergency Contact 1 Email

Emergency Contact 1 Purpose

Collection

Medical

Medication

Excursion

Emergency Contact first name

Emergency Contact last name

Emergency Contact 2 Relationship

Unit Number

Street Address

Suburb/Town

Postcode

Emergency Contact 2 Home Phone

Emergency Contact 2 Mobile Phone

Emergency Contact 2 Email

Emergency Contact 2 Purpose

Collection

Medical

Medication

Excursion

Declaration and Consent to Emergency Medical Treatment

I accept the terms and conditions

Yes

I am a person of lawful authority of the child referred in this enrolment form,

Declare that the information in this enrolment form is true and correct and undertake to immediately inform the children’s service in the event of any change to this information;
Agree to collect or make arrangements for the collection of the child referred to in the enrolment form if s/he becomes unwell at the service;
Agree that in the event of my child contracting an infectious or contagious disease, he/she may be excluded from care for the period of time recommended by my Doctor, or the Commissioner of Public Health;
Agree to pay childcare fees within fourteen (14) days of receiving my account, for all bookings made with my Childcare provider and accept that my care will be cancelled if I do not adhere to this agreement;
In the event of accident or illness, I/we authorise the educators to administer any medication that my child should require. I/we authorise the educator to seek medical treatment for my child, be it from a registered medical practitioner, hospital or ambulance service and agree to meet any expenses including ambulance costs, incurred
I/We have read and understand the terms and conditions governed by my application for care. I further agree to an internal credit check being conducted on my application for services provided by Latrobe City Council. I understand that the results of the credit check may determine my eligibility for care requirements
I/We have received a copy of the Early Learning Centre Fee Schedule and I accept the terms and conditions

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Child Care Agreement and Child Care Subsidy (CCS)

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