Carnaby Club Crèche Medical Form

Personal Details

Medical Information

Does your child suffer from any medical or physical condition that needs to be brought to the attention of the staff? (For example: allergies; anaphylaxis; disability; medical conditions).
 If yes, please record the medical condition on your childs member profile, under Health Conditions and Consents. If yes, please ensure an EpiPen with doctor's label is provided to Creche Staff upon Sign-in. If yes, please provide a copy to the Creche at: creche@cockburnarc.wa.gov.au 

Medical Authorisation

In the event of any accident or illness, I authorise staff to obtain medical treatment and/or transport by ambulance for my child and agree to pay expenses incurred for medical treatment and transport.

Please note that Cockburn ARC Creche staff are not authorised to administer medication to children with the exception of emergency medication such as EpiPens. If your child requires other medication during their time in the creche, the primary and/or secondary carers will be responsible for administration.

Emergency Contact and Authorisation to Collect Your Child

Please list a person who is authorised to collect and care for your child in your absence or if the parent/guardian is unavailable to be contacted in the event of any accident, injury, trauma or illness of the child.

Declaration