EmailMeForm
Additional Authorised Nominee Form
Please complete this form if you wish to authorise an additional authorised nominee.
An Authorised Nominee means a person who has
1. any person who is to be notified of an emergency involving the child if any parent of the child cannot be immediately contacted. This person is also authorised to collect the child from the service in the case of any such emergency where parents cannot be contacted.
2. been given permission by a parent or family member to collect the child from the education and care service.
3. any person who is authorised to consent to medical treatment of, or to authorise administration of medication to, the child; and
4. any person who is authorised to authorise an educator to take the child outside the education and care service premises;
Please indicate below which permission types are granted to each person. Please note that this is a mandatory requirement for enrolment
Name of Child
*
First
Last
Name of Child 2 (if applicable)
First
Last
Name of new Authorised Nominee
*
First
Last
Address of Nominee
*
Street Address
City
State / Province / Region
Postal / Zip Code
Nominee's Phone Nuimber
*
###
-
###
-
####
Date of Birth of Nominee
DD
/
MM
/
YYYY
Relationship to Child
*
Please indicate below which authorisations apply to this nominee. Please select as many as apply
*
1. This person is to be notified of an emergency involving the child if a parent of the child cannot be immediately contacted and is authorised to collect the child from the service if needed.
2. Authorised to Collect the child from the service.
3. Authorised to consent to medical treatment of, or to authorise administration of medication to, the child.
4. Authorised to authorise an educator to take the child outside the education and care service premises
Name of Parent Authorising this Nominee
*
First
Last
Signature of Parent
*
Clear
Parent Email
Date Time
*
DD
/
MM
/
YYYY
This form will be attached to your child's current Enrolment Form
