Add an Emergency Contact Form | Castle Hill Funhouse

Add an Authorised Nominee/Emergency Contact

To add additional Authorised Nominee's and Emergency Contacts to your account at Castle Hill Funhouse, please fill out the form below.

Children's Information

Child's Name

Child's Year Group

Authorised Nominee Information

Authorised nominee is a person who has been given permission by a parent or family member to collect the child from the education and care service or the family day care educator. See section 170(5) of the Law.

Contact's First Name

Contact's Last Name

Relationship to Child

Best Contact No.

Contact's Address

Contact's Email Address

Consent to administer medication and obtain medical treatment (including transport by an ambulance)

I authorise this person to authorise to consent to medical treatment of, or to authorise administration of medication to the child

Yes

Consent to take the child outside the education and care service premises

I authorise this person to authorise an educator Castle Hill Funhouse educator to take the child outside the education and care service premises?

Yes

Consent for transportation

I authorise this person to authorise the education and care service to transport the child or arrange transportation of the child

Yes

Consent for Emergency Contact

I authorise this person to be notified of an emergency involving my child if any parent of the child cannot be immediently contacted

Yes

Parent/Guardian Name

Parent/Guardian Signature

Today's Date