Enrolment and Permissions Form

Vaccinations*

Illness and medication history*
No medication will be given to a child without written consent from a parent or carer of the child concerned. Any medicine must be prescribed by a medical Doctor and have your child's name on the label. You must also complete a Medicine Consent Form to authorise us to give the medicine to your child each day if it is necessary.
I agree that in the event of an emergency, my child can be seen by a Doctor or healthcare professional or taken to hospital should the need arise.
Signature*

Clear
Print Name*
Date*

DayMonthYear
Date

Emergency Contacts
First Emergency Contact - Name*
Phone Number*

Area CodePhone Number
Relationship to child*
Second Emergency Contact - Name*
Phone Number*

Area CodePhone Number
Relationship to child*
Third Emergency Contact - Name*
Phone Number*

Area CodePhone Number
Relationship to child*
Please provide the details of two other people who you would like to be able to collect your child in addition to the main parents and carers. Please also upload photos of anyone who is authorised to collect your child.
Name, Telephone Number and Relationship to Child*
Name, Telephone Number and Relationship to Child*
File Upload - please send photos of anyone who is authorised to collect your child

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Immunisation Records