To be completed by the DOCTOR OR DIETITIAN and the PARENT/GUARDIAN.
This form is to be used where a child has a proven history of food allergy or intolerance
or requires a special diet for a proven medical condition.
This information is confidential and will be available only to supervising staff and emergency medical personnel.
First aid response to signs and symptoms of an allergic reaction/intolerance to a food or other substance.
Rose Park Community Childcare
1 week ago
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It is very important that you let these people know that you have nominated them. In nominating them you give them authority to act on the child's behalf if neither parent can be located, to pick up the child in an emergency and care for the child until she can be returned home.
The people nominated have been given approval ONLY to collect the child and should NOT be contacted in an emergency.
Does the parent/guardian/carer of this child have any of the following?
If this child attends another funded Preschool program please complete the following: