April 2021

All information is managed in accordance with ECU’s Privacy Policy located at www.ecu.edu.au/GPPS/policies_db/tmp/ad067.pdf

If you have more than one child in the program with a medical or custodial issue, you will need to complete a separate survey for each child. At the end of the survey (after you have clicked “Done”) you will need to return to the original link to enter any other children’s information.

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* 1. Your Child's Name (complete one survey/form per child)

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* 2. Your Child's Date of Birth

Date

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* 3. When is your child booked in the program?
(A separate form is required for each child.)

  AM PM Full Day
Tuesday 6 April
Wednesday 7 April
Thursday 8 April
Friday 9 April
Monday 12 April
Tuesday 13 April
Wednesday 14 April
Thursday 15 April
Friday 16 April

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* 4. Does your child have any allergies? (NOTE: we are unable to guarantee a nut-free or allergy-free environment)

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* 5. Will your child be required to take (or have on them) any medication whilst in our program?

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* 6. Does your child have one of the medical conditions listed below or any other that can be impacted by playing sport?

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* 7. To assist us to communicate with you in the event of an outbreak of a National Health and Medical Research Council (NHMRC) listed communicable disease, can you please confirm if your child is immunised in accordance with NHMRC guidelines?

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* 8. Is there any custodial information or any Family Court orders affecting your child(ren) that we should know about?

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* 9. In submitting this form I confirm that I have disclosed all relevant medical and health information for my child and have made Edith Cowan University (ECU) aware of all physical, mental or health conditions, which could be aggravated, worsened or impaired by my child participating in physical exercise or programs. I consent to medical treatment being administered to my child in an emergency.

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