I hereby give …………………………………., whilst having care of my child / children:

Name (s)………………………………………………………………  permission for the following:

 

To take photographs of my child / children, which may be used as a memento of something they have made or a party they may have attended, etc  YES - NO

 

To allow my child / children to sleep in a travel cot or in a buggy  YES - NO

 

To leave my child / children with another registered carer in an emergency  YES - NO

 

To keep written observations on my child / children’s  development  YES - NO

 

To travel on public transport should a situation arise  YES – NO

 

To travel in the childminder`s car when she or her husband is driving  YES – NO

 

To attend supervised outings, eg to go to places of interest, theme parks, zoos, national trust, etc               YES – NO

 

To visit the following local places eg shops, parent & toddler group  local parks, library, etc                         YES – NO

 

To administer emergency first aid  YES - NO 

(If NO, please put in writing any action you would like me to take)

 

To seek emergency medical advice / treatment if necessary   YES - NO 

 (If NO, please put in writing any action you would like me to take)

 

When this is necessary, to apply antiseptic, sun cream  provided by parents  YES – NO

 

To apply hypo-allergenic plasters  YES – NO

 

Please delete as appropriate.

 

Signature: ………………………………………………………………………………………………………

 

Date: ………………………………………………………………………………………………………

Parent’s name: ………………………………………………………………………………………………………

 

Address: ………………………………………………………………………………………………………

 

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