Relationship to Child. Date.....................................................
Relationship to Child. 2. Name: ………………………………………………….................. Telephone: ......………………………………….............................
Relationship to Child. Child(xxx)’s Doctor: ………………………………………....................... Telephone: .................…………….……….............................
Relationship to Child. 2. Relationship to Child: Title: MRS MR MS MISS Title: MRS MR MS MISS Surname: Surname: First Names: First Names: Home Phone: Home Phone:
Relationship to Child. Date: ......................................................................... Parent/Carers signature................................................................
Relationship to Child. If your child is attending any other Pre-Schools, please state the name of Pre-School and days they are attending: Name of School: ___________________________________________________________ Sessions and times attending _________________________________________________ Do you claim Early Years Education Entitlement at the additional Pre-School? If yes, how many sessions do you claim for? Sessions claimed for hours : _________________________________________________ If we find that we no longer need the place, we will inform the setting as soon as possible. Parent / Guardian Signature: Date: Emergency treatment declaration In the event of an accident or emergency involving my child I understand that every effort will be made to contact me immediately. Emergency services will be called as necessary and I understand my child may be taken to hospital accompanied by the setting manager (or authorised deputy) for emergency treatment and that health professionals are responsible for any decisions on medical treatment in my absence. I give / I do not give my consent for the appropriate medical treatment to be sought in the event of an emergency. Parent / Guardian Signature: Date: I give / I do not give my consent for staff to take the above named child to the nearest Accident and Emergency Unit to be examined, treated or admitted as necessary (we will always try to contact parent in the event of an accident). Parent / Guardian Signature: Date: For inhaler/Epipens only I give permission for a named member of staff who has been trained to administer the inhaler/Epipen or Anapen supplied by me to (name of child). The named staff are: 1. 2. 3. Parent / Guardian Signature: Date: Suncream I give / I do not give my consent for staff to administer hypoallergenic suncream as supplied by me to (name of child) when necessary and to record its use. Parent / Guardian Signature: Date: Plasters I give / I do not give my consent for my child to be administered plasters if required. Parent / Guardian Signature: Date: Short trip - general outings I give / I do not give my consent for (name of child) to take part in short trips or general outings. I understand that individual risk assessments are carried out for each type of trip or outing we take and are available for me to see as required. For any major outings, we will inform you and ask for your specific consent. Parent / Guardian Signature: Date:
Relationship to Child. Perpetrator(s) Yes: No: N/A: Yes: No: N/A: Yes: No: N/A: Yes: No: N/A: CHILDREN Indicate findings for each child. (Circle one) NAME 1) 2) 3)
Relationship to Child. I understand that this Shoreline Cooperative Preschool (SCP) is a cooperative preschool, and I agree to the following:
Relationship to Child. Surname...................................................................................................
Relationship to Child. I understand that I must deliver the medicine personally to the school office or my child’s teacher. I understand that I take responsibility for the medicine is in date and that I will provide replacement before the expiry date. I accept that this is a service that Xxxxxxx Xxxxx Xxxxxxxx XX Primary School is not obliged to undertake. I understand that I must notify the school of any changes in writing.
