Forms

Health Safety & Wellbeing Declaration Form

Health Safety & Wellbeing Declaration

I hereby notify Circle that my child has the following allergy/illness/disability/special needs that may require support and/or management during the course of their program participation.

Child's Name

First Name

Last Name

Special Need

General support/Management plan/Emergency treatment/action plan:

Signs & Symptoms:

Medication

Medication Name

Instructions

Please note: BC staff will act in the best interests of your child, seeking to safeguard their health and wellbeing at all times. BC ensure that at least one staff member with Senior First Aid training will be onsite at all times, however there is a limit to our ability to respond to all health emergencies. We reserve the right to call emergency services (and other specialist support, as required). BC do not accept responsibility for costs incurred (e.g. ambulance fees).

Parental Consent

I hereby provide my consent for BCI staff to provide support/care/emergency treatment to my child. In addition I provide my consent for BCI staff to contact specialist services, as the situation requires.

Parent's Signature

First Name

Last Name

Date

(08) 9193 6425

1800 853745