Childcare form

Child's Name

Date of Birth

Gender

Parent's Name

Mobile Number

Email Address

Emergency Contact Name

Emergency Contact Phone Number

Known Allergies or Medical Conditions

Is your child up to date with immunisations?

Any other information we should know

I agree
I understand that Majura Women’s Group provides an adjunct childcare which operates like a playgroup and that ultimately, I am responsible for my child/ren.

In the event of an accident, emergency and or injury while my child/ren are attending the adjunct childcare, I accept all liability and absolve Majura Women’s Group of any liability.

At no time will I leave the grounds of the Downer Community Centre while my child is still in the adjunct care of Majura Women’s Group.

For the safety and wellbeing of my child and other children, I will ensure that all doors are shut behind me and agree that the door to the two rooms will not be opened at any time during the session (only before and after the session has commenced).

I will sign my child in and out on arrival and prior to leaving.

Signature (Your full name) *

Your full name

Date