Common use of Custodial Statement Clause in Contracts

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Child’s doctor: Name: Phone: Name of medical centre: Health Illness/allergies: Is your child up-to-date with immunisations? Tick One Yes No (Please provide verification of all immunisations) For staff: Immunisation records sighted and details recorded: Tick One Yes No Medicine

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: ChildHealth: Doctor’s doctorName: NameMedical Centre: Phone: Name of medical centre: Health Illness/allergies: Is your child up-to-date with immunisations? Tick One Yes No (Please provide verification of all immunisations) For staff: Immunisation records sighted and details recorded: Tick One Yes No Medicine

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Health and Wellbeing Child’s doctor: Name: Phone: Name of medical centre: Health Health: If your child has a chronic illness please complete the attached chronic illness form. Illness/allergies: Is your child up-to-date with immunisations? Tick One Yes YesOne No (Please provide verification of all immunisations) For staff: Immunisation records sighted and details recorded: Tick One Yes YesOne No Medicine:

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: ChildHealth: Doctor’s doctorName: NameMedical Centre: Phone: Name of medical centre: Health Illness/allergies: No Is your child up-to-date with immunisations? Tick One Yes No (Please provide verification of all immunisations) For staff: Immunisation records sighted and details recorded: Tick One Yes No Medicine