20 Hours ECE Attestation: for 3, 4 and 5 year olds ... - Selwyn Toddlers

20 Hours ECE Attestation:for 3, 4 and 5 year olds1. Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service?Tick One Yes No2. Is your child receiving 20 Hours ECE at any other service/s? Tick One Yes NoIf yes to either or both of the above, please sign to confirm that:• Your child does not receive more than 20 hours of 20 Hours ECE per week across all services.• You authorise the Ministry of Education to make enquiries regarding the information provided in the EnrolmentAgreement Form, if deemed necessary and to the extent necessary to make decisions about your child’s eligibilityfor 20 Hours ECE.• You consent to the early childhood education service providing relevant information to the Ministry of Education,and to other early childhood education services your child is enrolled at, about the information contained in thisbox.Parent/Guardian Signature: _____________________________Date: ____ /____ / ____Optional Charges: 3 – 5 year olds ONLY (as per fee schedule)HOME BASED CARE AND EDUCATION1. Home based care educators charge optional fees of$_______________ per hour,3. The optional charge is for:□□□SunscreenHatsMeals□ Birthday and welcome packs ($28.00)Outings or special activities will be advised at the timeand a cost recovery maybe required.KINDERGARTEN2. Kindergarten & Discovery charges optional fees of$85.00( per term)4. The optional charge is for:□□□SunscreenHatsOnline- Journals and assessments for families□ Birthday and welcome packs ($28.00)□ Above required ratio of Registered support staff 1:7Outings or special activities will be advised at the time and acost recovery maybe required.5. I understand that if I agree to pay for the optional charge Selwyn Toddlers may enforce payment.6. The agreement to pay the optional charge for the full enrolment period and understand it will be reviewed annually7. The rules about making changes to the agreement are:• Reasonable opportunity of at least 4 weeks for both parents and Selwyn Toddlers to review any decisionsmade to the change s to optional charges.8. I understand that that optional charge is not compulsory and if I choose not to pay there will be no penalty.9. I understand this optional charge is not compulsory and if I choose not to pay there will be no penalty.10. I agree / do not agree (select one) to pay the optional charge for the activities/items specified in thisenrolment agreement formParent/Guardian Signature: ___________________________Date: ____ /____ / ____

Booking Details:Date of enrolment (TODAY): ____ /____ / ___ Date of entry (START): ____ /____ / ____ Date of Exit: ____ /____ / ____Days Enrolled:Ie: 9:00-15:00 Monday Tuesday Wednesday Thursday Friday Weekend TotalPlease note: 20 hours ECE is for up to six hours per day, up to 20 hours per week and here must be no compulsory fees when child is receiving 20 hours ECETimes enrolled:With this serviceEnrolled at anotherservice (list below)For 20 Hours ECE fill out the boxes below with the attested hours e.g 6 hours per day – 3 to 5 year olds ONLY20 Hours ECE atthis Service20 Hours ECE atany other serviceTotal number ofAttested HoursTotalTotalTotalParent/Guardian Signature: _____________________________Date: ____ /____ / ____Booking Details:Date of enrolment (TODAY): ____ /____ / ___ Date of entry (START): ____ /____ / ____ Date of Exit: ____ /____ / ____Days Enrolled:Ie: 9:00-15:00 Monday Tuesday Wednesday Thursday Friday Weekend TotalPlease note: 20 hours ECE is for up to six hours per day, up to 20 hours per week and here must be no compulsory fees when child is receiving 20 hours ECETimes enrolled:With this serviceEnrolled at anotherservice (list below)For 20 Hours ECE fill out the boxes below with the attested hours e.g 6 hours per day – 3 to 5 year olds ONLY20 Hours ECE atthis Service20 Hours ECE atany other serviceTotal number ofAttested HoursTotalTotalTotalParent/Guardian Signature: _____________________________Date: ____ /____ / ____