PARENTAL CONSENT FORM

To be completed and signed by the parent/guardian/carer and given to the setting. Please refer to the Guidance Notes which can be found at the end of this document. Parents/guardians/carers should notify the setting of any changes to the following details immediately.

CHILD
Full name (1) / Date of birth
Full postal home address
PHOTOGRAPHIC CONSENT
We sometimes take photographs of your child to record the activities they participate in. These photographs are generally used to share our experiences with you, the parents, but might also be used in Ofsted Inspections.
I agree for my child to be photographed.
Parent’s/guardian’s/carer’s signature (1) / Date:
TRANSPORTATION IN A CAR
I agree for my child to be transported in a car with any member of staff, working for Adams Fothergill Ltd, so long as appropriate car seats are used and car insurance has been obtained.
Parent’s/guardian’s/carer’s signature (1) / Date:
ROUTINE OUTINGS
I agree for my child being taken on routine outings.
Parent’s/guardian’s/carer’s signature (1) / Date:
USE OF SUNSCREEN, NAPPY CREAM AND BABY WIPES
I agree to the setting using following as and when required. Please click the boxes required.
Sunscreen Nappy Cream Baby Wipes
Parent’s/guardian’s/carer’s signature (1) / Date:
EMERGENCY MEDICAL INTERVENTION
I authorise Adams Fothergill Ltd to give permission for my child to receive any dental, medical or surgical (including anaesthetic) as considered necessary by the medical authorities present.
Parent’s/guardian’s/carer’s signature (1) / Date:
SLEEPING IN A PUSHCHAIR
I agree for my child to sleep in a pushchair under supervision.
Parent’s/guardian’s/carer’s signature (1) / Date:
PERMISSION TO HOLD PERSONAL DETAILS ON PC
I agree for personal details to be held on the setting’s PC for use in producing invoices and emergency contact details.
Parent’s/guardian’s/carer’s signature (1) / Date:
PERMISSION TO TALK TO OTHER PROFESSIONALS
I agree for Adams Fothergill Ltd to talk to other professionals, such as other settings, Health Visitors, PRESENS, EMAS, Social Workers etc.
Parent’s/guardian’s/carer’s signature (1) / Date:
DEVELOPMENTAL OBSERVATIONS
I agree for my child to be observed and for the information to be collected and recorded.
Parent’s/guardian’s/carer’s signature (1) / Date:
TAPESTRY
We would like to view my/our child’s development journal online via a secure login using the following details:
Email address
2nd Email address
Parent’s/guardian’s/carer’s signature (1) / Date:
SAFEGUARDING CHILDREN
I confirm that I have read the Safeguarding Children and Child Protection Procedures letter from the local Authority and understand that Fizzy Fish have a duty to contact the Front Door for Families (Multi Agency Safeguarding Hub) if they have any suspicions or concerns that a child has suffered or is at risk of suffering significant harm.
Parent’s/guardian’s/carer’s signature (1) / Date:
30 FREE ENTILEMENT (FUNDED) HOURS
I confirm that it is my responsibility to check every 3 months, that I am still eligible to receive these hours and to inform Fizzy Fish of any eligibility codes. If I cease to be eligible and fail to inform Fizzy Fish, I accept that I will be responsible for the additional fees.
Parent’s/guardian’s/carer’s signature (1) / Date:

Guidance Notes

The details above remain confidential except in the case of child protections issues. Please note that the setting has an obligation to report to Ofsted and the Child Protection Team any information that may relate to a child protection issue.

1.  The main carer who has signed the Contract should sign the form. On completion it should be given to the setting, who will then give the parent/guardian/carer a photocopy of the completed form.

Issue: 4/July 2017 Page 1 of 2

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