Child Minding Application

Delegate Contact Details

Please ensure the details entered below match your registration details.

First Name

Last Name

Organisation

Email Address

Verify Email Address

Mobile

Relationship to Child

Child Details

Child First Name

Child Last Name

Date of Birth

Immunisation Details

An Immunisation certificate is required before we can accept your application.

Permissions

As the primary contact for the child noted in this form, I understand that:

- Child Minding services will be offered at Ian Potter House (9 Gordon Street, Acton) and/or the Shine Dome (15 Gordon Street, Acton).
- Child Minding services will be offered by an external provider, paid for by the Australian Academy of Science
- All Child Minding staff are qualified and hold the necessary Working with Vulnerable People checks/cards
- At the time of completing the Child Minding Request Form, parents must supply the current and up-to-date immunisation for each child entering the Child Minding service

- I must supply the following:
                - Lunch and snacks-no nut products please
                - Nappies and wipes
                - Spare clothes
                - Hat
                - Comforters
                - Pram/stroller
                - Any other items required for the child throughout the duration of the child time at Child Minding service

- I must sign each child in and out of the Child Minding service
- I am the only person allowed to collect the child from the Child Minding Service, unless other arrangements have been made directly with the Child Minding staff
- The Australian Academy of Science and/or external child minding service provider reserve the right to refuse a child due to illness or infectious disease
- The Australian Academy of Science and/or external child minding service provider reserve the right to refuse a child due to care requirements being beyond the capacity of the Child Minding staff eg medication administration, specialist care.

Please select one of the following:

I permit Childminding staff to take my child outside for appropriate walks/play

I do not permit Childminding staff to take my child outside for appropriate walks/play

Please select one of the following:

I permit Childminding staff to apply sunscreen to my child if outside

I do not permit Childminding staff to apply sunscreen to my child if outside

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