Amendment to Child's Confidential Record

Update child details
Declaration and submit
Complete

You must complete this form for each child affected by this change.

The Kindergarten and or Family Day Care educator must collect the information in this form to meet regulatory requirements.

If you need help completing this form, please contact us on 9705 5200.

1. Child details

Given name(s) (required)

Surname (required)

Date of birth (required)

Does your child currently attend a City of Casey Kindergarten or enrolled into a City of Casey Kindergarten? (required)

Yes

If your child doesn't attend a City of Casey Kindergarten, you don't need to complete this form.

What year is your child attending kindergarten?

Name of kindergarten

What is the change or update you would like to make on your child's record? (required)

Making changes to Authorisations of people authorised as contacts for the child (other than parents)

Updating child's home address

Change of circumstances relating to Court order, parenting plans relating to the child

Changes to the child's specific medical conditions

Please select the change you wish to make to the authorities you provided on the Child's Confidential Record

add a new authorised person

remove an authorised person previously listed

replace all previously listed authorised persons

Child's home address

Suburb

Postal Code

Please upload copies with change of circumstances documents:

Select files

Maximum 5 files.
64 MB limit.
Allowed types: jpg, pdf, docx, png, doc.

Your child will not be able to attend kindergarten if you do not provided us with a copy of the current document(s).

Given name(s)

Surname

Authorised person home address

Suburb

Postal Code

At least one phone number is required *

Home phone

Mobile phone

Work phone

Relationship to your child

Please tick the boxes below to confirm the level of authorisation you give to this person.

This authorised contact can:

collect your child

be notified of an emergency involving your child if a parent cannot be contacted

authorise an educator to take your child outside kindergarten on excursions/regular outings

Add another authorised contact

I would like to add another authorised contact

Full Name

Authorised person home address

Suburb

Postal Code

Please enter the full address, including the unit/street number.

At least one phone number is required *

Home phone

Mobile phone

Work phone

Relationship to your child

Please tick the boxes below to confirm the level of authorisation you give to this person.

This authorised contact can:

collect your child

be notified of an emergency involving your child if a parent cannot be contacted

authorise an educator to take your child outside kindergarten on excursions/regular outings

Full Name

Contact 1

Full Name

Authorised person home address

Suburb

Postal Code

Please enter the full address, including the unit/street number.

At least one phone number is required *

Home phone

Mobile phone

Work phone

Relationship to your child

Please rick the boxes below to confirm the level of authorisation you give to this person.

This authorised contact can:

collect your child

be notified of an emergency involving your child if a parent cannot be contacted

authorise an educator to take your child outside kindergarten on excursions/regular outings

Add another authorised contact

I would like to add another authorised contact

Contact 2

Full Name

Authorised person home address

Suburb

Postal Code

Please enter the full address, including the unit/street number.

At least one phone number is required *

Home phone

Mobile phone

Work phone

Relationship to your child

Please tick the boxes below to confirm the level of authorisation you give to this person.

This authorised contact can:

collect your child

be notified of an emergency involving your child if a parent cannot be contacted

authorise an educator to take your child outside kindergarten on excursions/regular outings

Does your child have any changes to or new medical condition?

Yes

My child has been:

diagnosed as being at risk of anaphylaxis

prescribed an adrenaline auto-injector device (AAID)

diagnosed with asthma

diagnosed with epilepsy

diagnosed with diabetes

diagnosed with another condition

Action Plan

Select files

Note: Action plan must be signed by a doctor.

Unlimited number of files can be uploaded to this field.
10 MB limit.
Allowed types: jpg, gif, png, pdf.

Please describe the condition

Does your child have any changes to or new diagnosed allergies?

Yes

Download a copy of our Allergy Management Plan for your doctor to complete then upload it below. If you do not have access to print the Action Plan, please contact the City of Casey for a hard copy to be posted.

Allergy Action Plan

Select files

Unlimited number of files can be uploaded to this field.
10 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Does you child have any changes to or new dietary restrictions (including cultural)?

Yes

Please list your child's dietary restrictions

Privacy statement

We will handle any personal information you provided in this form in accordance with the Privacy and Data Protection Act 2014. You can access your personal information by contacting our Privacy Officer on 9705 5200. For more information please see our Privacy Policy.