Quick Links
Apply Now
Book a Tour

Search

About Our School
Programs
Montessori Learning
Enrolment
News & Events
- Parent Education
- Term Dates
Contact Us
Quick Links

Nominated Collection and Medical Consent Authorisation Form

>Nominated Collection and Medical Consent Authorisation Form

Nominated Collection and Medical Consent Authorisation Form

Your child’s safety is imperative to us. Therefore, we legally require written authority of nominated persons with permission to collect your child and/or be contacted in an emergency to consent to medical treatment on your behalf. If a nominated person is collecting the child they will be required to show photo identification, such as Drivers Licence.

Please list nominated persons below, who are over the age of 18, other than parents, and advise the relationship to the child and their authorisation. Please note, that we require at least one person, other than parents, to be nominated to be contacted in an emergency and to consent to medical treatment should we be unable to make contact with the parents at the time. For each person below tick all or some of the boxes, as applicable.

Nominated Collection and Medical Consent Authorisation Form

Student Name

First Last

Parent Name(Required)

First Last

Consent(Required)

I give permission to the persons specified below, to be responsible for the selected actions, for my child.

Nominated Person 1

Nominated Person 1

Select this box to enter details

Nomianted Person 1 Name(Required)

First Last

Relationship to Child(Required)

Contact Phone Number(Required)

Nominated Person 1 is:(Required)

Authorised to collect my child

Authorised to be contacted in an emergency and consent to medical treatment of my child

Nominated Person 2

Nominated Person 2

Select this box to enter details

Nomianted Person 2 Name(Required)

First Last

Relationship to Child(Required)

Contact Phone Number(Required)

Nominated Person 2 is:(Required)

Authorised to collect my child

Authorised to be contacted in an emergency and consent to medical treatment of my child

Nominated Person 3

Nominated Person 3

Select this box to enter details

Nomianted Person 3 Name(Required)

First Last

Relationship to Child(Required)

Contact Phone Number(Required)

Nominated Person 3 is:(Required)

Authorised to collect my child

Authorised to be contacted in an emergency and consent to medical treatment of my child

Nominated Person 4

Nominated Person 4

Select this box to enter details

Nomianted Person 4 Name(Required)

First Last

Relationship to Child(Required)

Contact Phone Number(Required)

Nominated Person 4 is:(Required)

Authorised to collect my child

Authorised to be contacted in an emergency and consent to medical treatment of my child

I acknowledge that the School will make immediate decisions as necessary, in the best interests of the child, such as administering an EpiPen. In the event that further emergency treatment is advised, I consent to the School, in the best interests of my child, and as it considers necessary or expedient (if reasonable attempts to contact the nominated 'emergency contacts' have failed) to:(Required)

Obtaining medical advice and treatment

Obtaining medical advice and treatment, except for the following treatments (list below):

List excluded treatments:(Required)

If the medical advice considers that the excluded treatment indicated above is necessary, I request that the School takes the following steps in its place: Parents to attach a document making instructions clear.

Max. file size: 8 MB.

Parent Signature(Required)

This permission is to be renewed at the commencement of each new School year. Permission is in place unless revoked through written authorisation.

ISMS is a Preschool and Primary School based in Sydney that delivers authentic Montessori education with Montessori trained teachers and a commitment to the Montessori philosophy

02 9555 7803
8.00am - 4.00pm
Email us

Balmain Campus
(Preschool & Primary)
and ISMS Administration

44 Smith Street Balmain
NSW 2041

Lilyfield Campus (Parent and Child, Preschool & Kindergarten)

10 Trevor Street Lilyfield
NSW 2040

Privacy Policy
Terms of Service
Site by Firefly

© 2024 Inner Sydney Montessori Association T/A Inner Sydney Montessori School — ABN 44 002 401 569