Additional Collection Contact Details
This form can be used to add extra authorised persons to the child’s original enrolment form.
Child's Full Name
*
Parent/Guardian Full Name
*
Parent/Guardian Signature
*
Details of people who you authorise to collect your child.
Your consent is required for other people to collect the child from the children’s service on your behalf. Please list the details of those people who can collect the child in the table below. This list may be added to or changed throughout the year. In the event that the child is not collected from the children’s service and the parents or guardians cannot be contacted, this list will also be used to arrange someone to collect the child.
Additional Contact Person 1 Details
Additional Contact Full Name
*
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Phone Number
*
Email
*
example@example.com
Relationship to child
*
Additional Contact Person 2 Details (optional)
Additional Contact Full Name
Address
Street Address
Street Address Line 2
Suburb
State
Postcode
Phone Number
Email
example@example.com
Relationship to child
Submit
Should be Empty: