Educator/Parent Agreement Form
To be used at the placement interview between both parent and FDC Contract Educator as a guide for discussion, and an agreement once the decision has been made to commence care. A copy of this form is to be is to be kept on child’s confidential file. A review date should be set after the first 2 to 4 weeks of care to ensure that the requirements of all parties are being met.
Date
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Month
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Day
Year
Date
Educator Name
First Name
Last Name
Parent/Guardian name
First Name
Last Name
1. Child's name
First Name
Last Name
2. Child's name
First Name
Last Name
3. Child's name
First Name
Last Name
The days and hours of the child's attendance are:
Orientation (fees applicable) and start date:
Hours of Care
Include who can pick up children, PINs, emergency contact information. Regulation 99, 158-159 & 168 Quality Standard 2&7
Notes
Fees
Fees discussed including how much fees are and when they need to be paid. Discuss core and non core hour costs and public holiday rates. Please include the booking fee charges for child absences. Refer to conditions of care
My fees are:
Current Administration levy is
Notes
Educational Program
Educational Program discussed. Include discussion around the learning outcomes and the types of documentation used. Encourage families to participate and contribute to the program where possible. Discuss play based learning and intentional teaching. Quality Area 1
Notes
Physical Environment
The physical environment is discussed with families and they are shown around the learning environment. Include where children will play and learn, where they will sleep if applicable and where they will eat. Discuss emergency evacuation procedures and where first aid kit is located. Quality Area 3
Notes
Residents and Visitors
Other residents and visitors discussed. Include how often they visit or are at home and whether they have WWCC and Police Checks. Discuss visitors registry, support visits and annual safety checks.Regulations 168 & 169
Notes
Routines
Discuss with family toileting including nappy changing and toilet training, hand washing, nose wiping, need for rest ect.
Note
Pets
Pets in the home discussed if applicable. Include where animals are located and if they are kept isolated from children (dogs and cats). if there are small animals please discuss small animal risk assessment. Quality Standard 2 & 3 Regulation 116
Notes
Photos and Videos
Photos and videos discussed. Include the need for written permission to be sort for photos or video of children to be used. Why photos/video are used for planning purposes and promotion.At times photos or videos may be taken to show the learning or development of a child in the service, these will only be taken with the child’s approval (verbally or by their actions), they will be respectful and used externally only with written authorisation if they show a child’s face. Please discuss what this looks like in your service.
Notes
Television and Electronic Media
Discuss television and electronic media use. Recommendations of use. How it’s documented in the program. How much do the children use them at home? G Rated only policy. Any objections or concerns? Quality Standard 1,3&6
Notes
Active Play
Discuss what active play looks like in your program It is recommended that children of ages 1-5 years have at least 3 hours of active play, some that ensures a child’s heart rate increases. Talk to families about what that looks like in their home and in your setting.
Notes
Excursions and Events
Discuss what excursions and events look like in your program. Discuss : Authorised use of cars and approved child restraints. ( if applicable) Regular and Non Regular outings of FDC Contract Educator. (emergency evacuation, kinder pickups, walks to the park, scheme organised events etc) Regular or non-regular excursion authority and risk assessment forms to be completed prior to all outings outside of the home. Explain Transport Policy and five point safety check (if applicable) Quality Standard 2,4,6&7 Regulation 110-112,168
Notes
Food and Drinks
Discuss healthy eating and who will provide the food and what suitable foods to be provided,costs, joint arrangements, food handling, safe storage, various options with other families. Special dietary/allergy requirements. Food safety and nutrition policies. Preparation of formula and storage/reheating of breast milk. Quality Standard 2,3 &7 Regulation 77,78,79,80,90
Notes
Medical Action Plans
Discuss if children have additional needs or medical conditions? If yes, discuss Medical Management Plan and Medical Condition Risk Minimisation and Communication Plan. Procedures when child/ren become ill during the day. Notice of illness report. Immunisation and Infectious diseases policy. Emergencies. FDC Contract Educator illness. Emergency procedure, ambulance coverage.
Notes
Medication
Discuss the scheme’s policy and record of medication administered form, storage. Is/are the child/ren on regular medication? All unprescribed medication must have a doctors letter provided (eg paracetamol)
Notes
Sun Smart
Combination of sun protection measures – hats sunscreen,clothing to cover as much skin as possible, role modelling, particular care when UV index levels reach their peak during the day. Quality Standard 2 & 7, Regulation 168
Notes
Social Media
Discuss the use of social media in FDC, refer to photo/video policy. Let families know about our Instagram page @geelongchildrenandfamily and our Facebook Page Geelong Child and Family.
Note
Child Safe Standards
The City of Greater Geelong Family Day Care service is committed to child safety. We want children to be safe, happy and empowered. We support and respect all children we have a zero tolerance to child abuse. I have signed a Statement of Commitment to uphold the Child Safe Standards 2016, in doing so I am obligated to report any incident I believe may endanger a child, not only in my care but within my community. I have a zero tolerance for child abuse, and I will report to my Coordination Unit any incident I feel may jeopardise the safety and wellbeing of children. If I feel a child may be in immediate danger, I will call 000.
Safe Sleeping
Our policies and procedures are based on current research and recommended evidence-based principles and guidelines provided by Red Nose Foundation (formerly SIDS and Kids) as they are considered the recognised national authority on safe sleeping practices for infants and children. Discuss the individual sleep or rest needs of their child with eg:- where they’ll sleep, - what they will sleep on/in, - provision of bedding, and - regularity of sleep checks, document the agreed times to check sleeping children (and the impact these have on the supervision they have of awake children). - any risk factors that need to be considered (eg: premature, smoking household, chest infections, asthma, tummy sleeper). - removal of choking hazards (jewellery, toys, dummy cords) - where you and the other children will be during sleep/rest periods
Please list any risk factors. If any risk factors evident children will need to be physically checked more regularly as recommended by the SIDS Guidelines. All other children must be checked a minimum 15-20 minutes.
Parent/Guardian Signature
Date
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Month
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Day
Year
Date
Parent Email address for a copy of agreement
example@example.com
Educator signature
Date
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Month
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Day
Year
Date
Date for review of agreement
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Month
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Day
Year
Date
Your email address
*
example@example.com
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