Someries Infant School and Early Childhood Education Centre's Parental Agreement for the school to administer intimate care

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Your child's name* This field is required.
First Name
Last Name
2
Your child's date of birth* This field is required.
Date
Day
Month
Year
3
I give permission for Someries Infant School and Early Childhood Education Centre staff to provide appropriate intimate care support to my child.* This field is required.This includes, but is not limited to, changing soiled clothing, changing nappies, washing and toileting.
YESNO
4
You have indicated that you do not give consent for your child to be given intimate care (e.g. to be washed and changed if they have a toileting accident).

By completing this form you are declaring that you understand that the school will contact you or your child's emergency contact and you will be required to organise for your child to be given intimate care (e.g. be washed and changed).

By completing this form you are declaring that you understand that if the school cannot reach you or your child's emergency contact, and if your child needs urgent intimate care, staff will need to provide this for your child, following the school’s intimate care policy, to make them comfortable and remove barriers to learning.
5
I will advise the school of anything that may affect my child’s personal care.* This field is required.This includes, but is not limited to, if medication changes or my child has an infection.
YESNO
6
Your name* This field is required.
First Name
Last Name
7
Your relationship to the child named in this Agreement* This field is required.
8
Your email address* This field is required.You will receive a copy of this submission via email
9
Signature* This field is required.
Clear
10
Date and time of submission of this Parental Agreement* This field is required.
Date
Day
Month
Year
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Hour
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Minutes
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Privacy Notice* This field is required.
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