Phone: Family Dentist: Dentist Name: Address: Phone: Medicare Details: In case of an emergency having details makes treatment of your child’s injuries quicker. Please remember to update your details if your Medicare card is replaced (especially if it has been reported as lost or stolen). CONSENTS: Children covered by consent: I give the following consents for my children: Child 1 Name: Child 2 Name: 3 Name: Child 4 Name: Attendance Consent: To receive out of school hours care conducted by Engadine West Public School P & C Before and After School Care as indicated by me on this form. I understand that all due care will be taken by Engadine West Public School P & C Before and After School Care and that the Centre or supervisors will not be held responsible for any loss or damage to property brought to the Centre during any/all program components. □ □ □ □ Yes Yes Yes Yes Child 1 Child 2 Child 3 4 □ □ □ □ No No No No (Please tick) Emergency Consent: I give permission for the staff to seek medical attention for my child/ren in the event of an accident or emergency which cannot be treated by basic first aid and agree to meet any expenses as a result. □ □ □ □ Yes Yes Yes Yes Child 1 Child 2 Child 3 Child 4 □ □ □ □ No No No No (Please tick) Medical Consent: To receive medical attention when necessary or to be released into the care of a medical or dental practitioner or medical personnel as deemed necessary and agree to meet any expenses as a result. □ □ □ □ Yes Yes Yes Yes Child 1 Child 2 Child 3 Child 4 □ □ □ □ No No No No (Please tick)
Phone: Family Dentist: Dentist Name: Address: Phone: Medicare Details: In case of an emergency having details makes treatment of your child’s injuries quicker. Please remember to update your details if your Medicare card is replaced (especially if it has been reported as lost or stolen). CONSENTS: Children covered by consent: I give the following consents for my children: Child 1 Name: Child 2 Name: 3 Name: Child 4 Name: Attendance Consent: To receive out of school hours care conducted by Engadine West Public School P & C Before and After School Care as indicated by me on this form. I understand that all due care will be taken by Engadine West Public School P & C Before and After School Care and that the Centre or supervisors will not be held responsible for any loss or damage to property brought to the Centre during any/all program components. Child 1 (Please tick) □ Yes □ No Child 2 □ Yes □ No Child 3 □ Yes □ No 4 □ Yes □ No Emergency Consent: I give permission for the staff to seek medical attention for my child/ren in the event of an accident or emergency which cannot be treated by basic first aid and agree to meet any expenses as a result. Child 1 (Please tick) □ Yes □ No Child 2 □ Yes □ No Child 3 □ Yes □ No Child 4 □ Yes □ No Medical Consent: To receive medical attention when necessary or to be released into the care of a medical or dental practitioner or medical personnel as deemed necessary and agree to meet any expenses as a result. Child 1 (Please tick) □ Yes □ No Child 2 □ Yes □ No Child 3 □ Yes □ No Child 4 □ Yes □ No
BASC_Enrolment_Form-2018.docx