2023 LOOSH Enrolment

Child's name*

First Last

What school does your child attend?*

Leichhardt Public School

St. Fiacres Primary School

Other

Other*

Does your child have a diagnosed disability or medical condition?*

Yes

No

What is your child's disability/medical condition?*

Do you think that your child would be able to participate at our centre with a ratio of one educator per 15 children.*

Yes

No

Has your child accessed additional support (such as an additional support worker) in a previous OOSH, daycare or school?*

Yes

No

Please provide the name/contact of any previous centres your child has attended. LOOSH may contact them to gather information to assist the inclusion and support of your child at the service. (name/phone number/email)

Please give a brief description of your child's disability/ medical condition

Is your child fully independent in regards to toileting and hygiene?*

Yes

No

If no, please describe what assistance your child requires

Is your child fully independent in regards to eating and drinking?*

Yes

No

If no, please describe what assistance your child requires

Does your child recognise and know how to deal with common childhood dangers such as road sense, stranger danger, hot or sharp objects etc?*

Yes

No

Please describe any supervision/assistance your child may need in the folowing areas:

General play:

Organised activities/games:

Excursions:

Child's interactions at LOOSH

What activities / games / toys does your child enjoy?*

Does your child fully understand verbal communication?*

Yes

No

If no, please tell us your child's level of understanding?

Does your child communicate verbally?*

Yes

No

Partially

If no or partially was selected, please describe how your child communicates and if there are any special signs, sounds or gestures your child uses for everyday communication such as toilet/drink/upset etc.

Describe how your child interacts with other children

Describe how your child interacts with adults/Educators

Child's behaviour

Please describe anything specific that upsets your child

What methods do you use to calm your child if they become upset, angry, overexcited or exhibit inappropriate behaviours?

Is your child aggressive towards others?*

Yes

No

If yes, under what circumstances and how do you deal with it?

Does your child wander, abscond or run away?*

Yes

No

If yes, please give details to assist educators

Do you have a behaviour management plan for your child?*

Yes

No

If yes, please provide details to assist educators and provide a consistent approach for the child.

Medical information

Describe any activities that your child should not do or will be restricted by, due to medical or health reasons.

Does your child take any ongoing prescribed medications? (please include medications even if they will not be administered at the service)*

Yes

No

If yes, please list the medication/s and how of often they are administered.

Does your child have any mobility issues?*

Yes

No

If yes, please outline any implications this may have on the care for your child.

Please give details of any sensory impairments to assist educators in successful interactions with your child

Does your child experience seizures?*

Yes

No

If your child does experience seizures, please answer the folllowing questions

*Please note that you will be required to supply a seizure action plan to the service before the child can start attending.

What type/s of seizures does your child experience?

Are there any warning signs before a seizure?

How often do seizures occur?

Is there any further information you would like to share that educators should be aware of or that may help your child while at LOOSH?

Please attach any diagnosis, medical information/ action plans or additional resources that may assist us in supporting your child at LOOSH

Drop files here or

Max. file size: 300 MB.

Parent/Guardian name*

First Last

Signature*

Date*

Email

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