Settlement Kids After-School Programs

Enrolment Form

This form is to be completed by parents and caregivers who are interested in their children attending The Settlement Kids After-School Programs. This program is for children who are in primary school.

All children who have previously attended our program are required to re-enroll to help us keep our information as up to date as possible.

If you have any questions please contact Travis: travis@thesettlement.org.au or Kate: kate@thesettlement.org.au or contact us on

0473 235 591.

Child's Details

Child's First Name *

Last Name *

Cultural Background/Identity *

Gender *

Date of Birth *

Current Age *

Current Grade at School *

Residential Address *

Your child's school *

Alexandria Park Community SchoolDarlington Public SchoolJarjum CollegeOther School

Was your child enrolled in our 2025 After School Programs? *

YesNo

If yes, have all your details remained the same (i.e. Carer Details, Medical Information, Emergency Contact and Authorised Persons for PickUp)? *

YesNo

Primary Parent/Carer Details

Name *

Relationship to child *

Phone Number *

Email Address *

Emergency Contact Details

Emergency Contact 1 Name *

Emergency Contact 1 Phone Number *

EC1 Relationship to child *

Emergency Contact 2 Name *

Emergency Contact 2 Phone Number *

EC2 Relationship to child *

Medical Information

Child's Medicare Number *

Child's CRN

Does your child have any allergies, food intolerances or cultural food preferences? *

NoYes

If yes, please specify details of allergies, food intolerances, or cultural preferences *

Does your child have any medical conditions? *

NoYes

If yes, please specify details of medical conditions or diagnosis *

Does your child require any medication to be taken during program hours 3pm-5pm? *

NoYes

If yes, please specify medication and instructions (You will also need to fill out a Medication Form and provide an Action Plan on their first day) *

Does your child have any other diagnosis or behavioral information that would be useful for us to know? *

NoYes

If yes, please specify details *

Authorised Persons

Please specify the people who are authorised to pick up your child from Settlement Programs. If you require someone who is not included on this list to pick up your child on occasion, you must let us know by calling or texting the program phone.

The Settlement is unable to release any child to an adult that does not have prior permission from the primary parent/carer.

Person Authorised to pick up your child 1 *

Authorised Person 1 Relationship to child *

Person Authorised to pick up your child 2

Authorised Person 2 Relationship to child

Person Authorised to pick up your child 3

Authorised Person 3 Relationship to child

Is there any important information regarding your child’s safety and/or pick up arrangements that you would like us to be aware of? For example Non-Authorised Pick ups, existing AVOs etc *

NoYes

If yes, please provide details *

Term 1 2026 Program Enrolment

The Settlement After School Programs will start back on Tuesday February 10th (week 2 of school)

For Term 1 programs will continue to run 3-days a week (Tuesday, Wednesday and Thursday)

Tuesday - Kids in the Kitchen @ The Settlement

Wednesday- Park Day @ Alexandria Park

Thurday- Swim Lessons @ Cook and Phillip Park Pool

*please note there are limited spaces for swim lessons and there may be a waitlist*

Please indicate below if you would like to enrol your child on Tuesdays *

YesNo

Please indicate below if you would like to enrol your child on Wednesdays *

YesNo

Please indicate below if you would like to enrol your child on Thursdays *

YesNo

Program School Pick Up & Home Drop Off

Please note that our Bus Drop-Home service is extremely limited and we are unable to drop everyone home.

If you are able to pick up your child from the program on any day of the week, please let us know as this will help us make sure that as many children as possible can participate in our programs.

If you live closeby to The Settlement, we may request that you pick up your child from the program to allow bus spaces for children who live further away.

Please indicate your pick up preference for your child to attend our programs: *

I would like my child to be picked up from Alexandria Park SchoolI would like my child to be picked up from Darlington Public SchoolI/Someone else will drop my child to the program

Please indicate your drop off/pick up preference for your child after our programs on Tuesdays. *

I would like my child to be dropped home after the program (Redfern/Waterloo or Alexandria/Eveleigh addresses only)I/Someone else will pick up my child from the program at 5pm

Please indicate your drop off/pick up preference for your child after our programs on Wednesdays *

I would like my child to be dropped home after the program (Redfern/Waterloo or Alexandria/Eveleigh addresses only)I/Someone else will pick up my child from the program at 5pm

Please indicate your drop off/pick up preference for your child after our programs on Thursdays. *

I would like my child to be dropped home after the program (Redfern/Waterloo or Alexandria/Eveleigh addresses only)I/Someone else will pick up my child from the program at 5pm

Is the address that your child will be dropped to your residential address? *

Yes it is the same residential address as aboveNo, it is a different address

Please identify the different drop-off address below *

General Permissions

Expectations of Enrolment

To ensure that The Settlement provides an environment where children feel physically and psychologically safe, we require that both children and their families understand the following Settlement rules:

Show respect for themselves, each other, staff and the community
Respect other people's property and that of the service
Share with other children and be inclusive
Accept and respect individual needs and differences
Clean up after activities
Follow the instructions given by staff
Play only in the allocated areas and as directed by staff and not enter areas that staff have designated as “out of bounds”
Remain in the supervised area of the program until the authorised person collecting them has signed them out
Use appropriate language at all times.

Zero Tolerance

The Settlement holds a zero-tolerance policy for the behaviours listed below.

Blatant disrespect of staff
Partaking in any action which causes harm to themselves or others (i.e.physical violence) For example, hitting, kicking, spitting etc.
Bullying or engaging in antagonistic/aggressive behaviour.
Running away from program areas (specifically out The Settlement’s door, onto roads etc)

In the interest of maintaining the safety of all children and staff,The Settlement may be required to implement an agreed upon ‘break’ from the program as a response to partaking in any of these behaviors. A ‘break’ is temporary and would entail missing at minimum one program day.

If inappropriate behaviour becomes persistent and continue over a period of time, a meeting between staff, nominated supervisor, child and family will be arranged.

I agree to the expectations of enrolment and specifically the processes surrounding the zero tolerance rule (i.e. break from program) *

Authorisation

I agree that the above information is correct and if any changes in information for my child occurs that I will inform the Settlement

*

I have the Settlement Children's Program Phone Number (0473 235 591) saved in my phone and will inform the Settlement Team if my child will be absent from the program on a day that they are enrolled *

I have read, understand and will ensure that my child understand the Settlement Program Rules *

I give my permission for my child to participate in the program that is being run by the Settlement Neighbourhood Centre. I understand that certain risks and dangers exist in some of the activities and travelling to and from these activities. Although all reasonable care will be taken of participants, I will not hold The Settlement Neighbourhood Centre or any staff employed or associated with The Settlement Neighbourhood Centre responsible in case of accident or illness during the period of the activity.

*

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Parent/Carer Full Name *

Today's Date *