Authorisation to collect the child from care

To protect your child’s safety, only authorised people can collect your child from their early learning centre.

All Centre visitors must follow Woden Valley ELC Visitors to the service policy and Code of Conduct for Families.

** WVELC is bound to protect the privacy of children, families and educators. Educators are only permitted to have access to personal information for professional and administrative purposes. Only information relevant to the centre will be kept on file.**

Child's Details

My child is currently enrolled in:

Child's Last Name *

Child's Given Names *

Date of Birth *

Parent / Guardian Details

Legal guardian completing this form

Parent 1 - Last Name *

Parent 1 - Given Names *

Parent 1 - Phone Number / Mobile *

Authorised Person Details

I understand that the authorised person must produce photographic identification if requested, or my child will not be released to them. *

Suppose the centre has any doubt about the authorised person's ability to care for the child or safely transport them to the parent/guardian. In that case, the responsible person in charge has the right to refuse the child's release to the person, and the parent/guardian or ACT Police may be called. *

Authorised Person - Full Name *

Authorised Person - Relationship to child *

Authorised Person - Date of birth

Authorised Person 1 - Residential address

Authorised Person - Phone number

I give my permission for the above person to collect my child from Woden Valley Early Learning Centre. *

My child is familiar with that person and will willingly leave the Service with them. *

The authorised person has authority to collect my child from care on the following days: *

One-off pick upPeriod of timeOngoing pick up

Please specify date / dates

Does the above person require language support / translator?

YesNo

DECLARATION
I hereby declare that the information provided is true and correct. I have a legal right to authorise the above person to collect my child from Woden Valley Early Learning Centre. I have complete confidence that the authorised person is capable of caring for my child. *

Sign here *

Draw signature|Type signatureClear