__________________________________________________________________________________________________ NOTE: The service cannot enforce custody issues without a copy of the relevant Court Order being provided. Please discuss any custody issues with the Nominated Supervisor before enrolment. SECTION 5: EMERGENCY CONTACTS I hereby authorise the staff of the service to contact the following people, if I cannot be contacted, in the case of an emergency. Please supply at least 2 names, other than the child’s parents/guardians. NAME ADDRESS MOBILE WORK PHONE RELATIONSHIP TO CHILD NOTE: It is important that you inform the above people that you have included them as emergency contacts and that they may be contacted in the case of an emergency, with your child or the service, and asked to collect your child when you can not be contacted Medical treatment/authorization for medication I hereby authorise the staff of the service to contact the following people, if I cannot be contacted, in the case of the need to consent to medical treatment of my child or to authorize administration of medication to my child. Please supply at least 2 names, other than the child’s parents/guardians. NAME ADDRESS MOBILE WORK PHONE RELATIONSHIP TO CHILD NOTE: It is important that you inform the above people that you have included them as emergency contacts and that they may be contacted in the case of an emergency, with your child or the service, and asked to consent to medical treatment for your child or an authorization for medication when you can not be contacted Care and Well being of my child I hereby authorise the following people, to authorize an Educator to make decisions regarding the care and well being of my child. EG. Permission to attend a change of venue for an excursion. Please supply at least 2 names, other than the child’s parents/guardians. NAME ADDRESS MOBILE WORK PHONE RELATIONSHIP TO CHILD
__________________________________________________________________________________________________ NOTE: The service cannot enforce custody issues without a copy of the relevant Court Order being provided. Please discuss any custody issues with the Nominated Supervisor before enrolment. SECTION 5: EMERGENCY CONTACTS I hereby authorise the staff of the service to contact the following people, if I cannot be contacted, in the case of an emergency. Please supply at least 2 names, other than the child’s parents/guardians. NAME ADDRESS MOBILE WORK PHONE RELATIONSHIP TO CHILD NOTE: It is important that you inform the above people that you have included them as emergency contacts and that they may be contacted in the case of an emergency, with your child or the service, and asked to collect your child when you can not be contacted Medical treatment/authorization for medication I hereby authorise the staff of the service to contact the following people, if I cannot be contacted, in the case of the need to consent to medical treatment of my child or to authorize administration of medication to my child. Please supply at least 2 names, other than the child’s parents/guardians. NAME ADDRESS MOBILE WORK PHONE RELATIONSHIP TO CHILD NOTE: It is important that you inform the above people that you have included them as emergency contacts and that they may be contacted in the case of an emergency, with your child or the service, and asked to consent to medical treatment for your child or an authorization for medication when you can not be contacted Care and Well being of my child I hereby authorise the following people, to authorize an Educator to make decisions regarding the care and well being of my child. EG. Permission to attend a change of venue for an excursion. Please supply at least 2 names, other than the child’s parents/guardians. NAME ADDRESS MOBILE WORK PHONE RELATIONSHIP TO CHILD
enrolment_form_template_update_Oct2015.docx