Children'S Services Enrolment Form Part B: Family Form (Page 2 of 4) in pdf

Children'S Services Enrolment Form Part B: Family Form Page 2

To better support you and your child are you or a member of your family affected by:

 Mental Health

 Physical Illness

 Grief

 Family Separation

 Family Violence

 Refugee Statue

 Other e.g. fear ___________________________

Authorisation

Authorised nominee means a person who has been given permission by a parent or family member to

collect the child from the education and care service or the family day care educator. See section 170(5) of

the Law.

Photo ID of the Authorised nominee is needed on their first visit to collect a child.

Please provide the name, address and contact details of any person who is an authorised nominee;



To authorise medical treatment for your child



Be notified in an emergency where the parent/guardian can’t be immediately contacted



Provide permission for excursions



Collect the child from the service



If you have no authorised nominee and you are the only authorised person for your

( Please tick)

child/dren. (You will be required to be contactable at all times whilst your child is in education and care).

Please note: in the event of an incident if you are not contactable then the appropriate authorities will be

notified.

Authorised nominees other than Parents/Guardians are authorised to:

Name:

 Yes (please tick)

 Collect my child from the service

Relationship to child:

 Complete excursion permission forms for my child

Address:

 Consent to medical treatment for my child

Post Code:

 Complete medication details for my child

Telephone/s: (H)

 Be notified in the event of any incident, injury,

trauma or illness to my child/children

(W)

(M)

Name:

 Yes (please tick)

 Collect my child from the service

Relationship to child:

 Complete excursion permission forms for my child

Address:

 Consent to medical treatment for my child

Post Code:

 Complete medication details for my child

Telephone/s: (H)

 Be notified in the event of any incident, injury,

trauma or illness to my child

(W)

(M)

Name:

 Yes (please tick)

 Collect my child from the service

Relationship to child:

 Complete excursion permission forms for my child

Address:

 Consent to medical treatment for my child

Post Code:

 Complete medication details for my child

Telephone/s: (H)

 Be notified in the event of any incident, injury,

trauma or illness to my child

(W)

(M)

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Children'S Services Enrolment Form Part B: Family Form Page 2

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