Education in New Zealand. The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, which if received, should be securely destroyed once verified. ♦ Parents / Guardians:
Education in New Zealand. The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, when if received, should be securely destroyed once verified. For Office Use Only Identity record copied for NSN (if required) Immunisation record copied and held with enrolment ID Securely Destroyed: / / Signature: Date of Entry: Date of Exit: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare Queenstown. Parents / Guardians Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Emergency Contacts (Adults who are permitted to pick up your child – other than the above) Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Relationship to child: First name: Surname / family name: Address: Relationship to child: First name: Surname / family name: Address: Phone (mobile): Phone (home): Phone (work): Email: Phone (mobile): Phone (home): Phone (work): Email: Custodial Statement Are there any custodial arrangements concerning your child? Yes No If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required): Name of person/s who CANNOT pick up your child: Name: Name: Name: Name: Any changes to this form must be signed and dated by both the parents/caregiver and City Impact Church Childcare Queenstown. Child’s Doctor Name of Medical Centre: Name of Doctor: Phone: Child’s Health Early childhood services are required, as per the Health (Immunisation) Regulations 1995, to ask parents or guardians of a child to provide the Immunisation Record for each child attending their service and record the information from the Immunisation Record – or the fact that was not shown – on the Immunisation Register. Illness / Allergies: Is your child up-to-date with immunisations? (Please provide verification of all immunisations) Yes No For staff: Immunisation records sighted and details recorded Yes No Medicine
