Daycare Form

Document Sample
Daycare Form
Family day care

Moving to regulation

Complete one form for each family day care scheme.





Family day care scheme



1 Name of family day care scheme:



Geographic region of scheme (eg. suburb/s or LGA/s:



Scheme coordinator’s name:



Position:



Tel: Fax:



Email:



Postal address:



Suburb: Post code:



Venue/street address:



Suburb: Post code:





Family day care staff



2 How many staff does the family day care scheme employ? No. Staff: Full time equivalent:



3 How many carers are within the family day care scheme? No. Carers:



4 Does the family day care scheme employ the carers? Yes No



5 Are there family day care carers in the scheme that do not use English as their first language? Yes No



6 If yes, indicate the languages required for translation of materials for consultation.









Operation of the family day care scheme

7 Does the family day care scheme currently provide overnight care? Overnight care is care offered between 6pm and 6am. Yes No

8 Does the family day care scheme currently provide 24-hour care? 24-hour care is care for a period longer than 24 hours. Yes No

9 Does the family day care scheme provide in-venue care? In-venue care is where the care location is a community Yes No

venue, rather than in a carer’s home.

10 Does the family day care scheme provide care for school-aged children? Yes No

11 Does the family day care scheme run play sessions? Yes No

12 Does the family day care scheme run a toy library? Yes No

13 Is the scheme registered to undertake Family Day Care Quality Assurance (FDCQA)? Yes No

14 Does the family day care scheme check the criminal record of:

– Scheme staff that have contact with children Yes No

– Carers Yes No

– Other adults residing in the carer’s home Yes No

15 On average how often do staff employed by the family day care scheme visit each carer? At least once per month Between 4 to 6 months

Between 1 to 3 months Greater than 6 months



NEXT go to question 16

OFFICE USE ONLY Date received: Date entered: Other:



Department of Human Services

This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)

Family day care sponsor



16 Name of sponsor:



Name of sponsor contact person:



Position:



17 What is the status of the family day care sponsor? For profit

Non-profit

Government



18 What is the legal status of the family day care sponsor? Incorporated Association

Corporation

Company

Co-operative

Individual or Partnership

Local Government Authority

Don’t know

Other (provide detail)



19 Does the sponsor also provide Commonwealth funded in-home care? Yes No





Initial comments

20 Do you have any initial comments about the development of regulations for family day care schemes or outside school hours care services?









Equipment bonus

21 I am aware that the Office for Children will send an equipment bonus grant of $300.00 (GST excl.) to the scheme in January 2006 following the

receipt of this form and that acquittal by providing a tax invoice will be required.





Sponsor authorisation

22 The Office for Children is collecting this information for the purposes of establishing a register of all existing family day care schemes and outside

school hours care services as the first step in developing regulations. The information you provide will be used to communicate with you about

regulations and to enable consultation and analysis.



Person with authority to sign on behalf of sponsor



Name:



Title:





Signature:





Thank you for taking the time to complete this form. Please return this family day care form by 16 December 2005, in the reply paid envelope provided.

(Address: Register, Office for Children, Department of Human Services, GPO Box 4057, Melbourne Vic 3001)

If you have any questions about the register or equipment bonus, please telephone the Office for Children on 1300 667 182.



This document is managed by the Department of Education and Early Childhood Development, Victoria (as of 27 August 2007)


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