Skip to content
Search
Search
Enrol Now
Our Services
Early Learning
School Age Care
Vacation Care
All Services
Parent Resources
Careers
Careers
Find A Job
Ambrose Pathways
About Us
Contact
Menu
Enrol Now
Our Services
Early Learning
School Age Care
Vacation Care
All Services
Parent Resources
Careers
Careers
Find A Job
Ambrose Pathways
About Us
Contact
Emergency Contacts/Authorised Nominees Update
Please note: If any details are missing we will not be able to process your request so please ensure all fields are completed.
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Emergency Contacts / Authorised Nominees Update Form_V1.1 Revised October 2021
Child's Name
*
First
Last
Select your Service
*
Please Select
Ambrose Activities Santa Sophia Box Hill (Gables)
Ambrose Activities St Luke's Marsden Park
Ambrose Activities St Madeleine's Kenthurst
Ambrose School Age Care Bethany Glenmore Park
Ambrose School Age Care Chisholm Bligh Park
Ambrose School Age Care Christ the King North Rocks
Ambrose School Age Care Corpus Christi Cranebrook
Ambrose School Age Care Good Shepherd Plumpton
Ambrose School Age Care Holy Cross Glenwood
Ambrose School Age Care Holy Family Emerton
Ambrose School Age Care Holy Family Granville East
Ambrose School Age Care Holy Family Luddenham
Ambrose School Age Care Holy Trinity Granville
Ambrose School Age Care Mary Immaculate Quakers Hill
Ambrose School Age Care Mother Teresa Westmead
Ambrose School Age Care Our Lady of the Angels Rouse Hill
Ambrose School Age Care Our Lady of Lourdes Baulkham Hills South
Ambrose School Age Care Our Lady of Lourdes Seven Hills
Ambrose School Age Care Our Lady of Mount Carmel Wentworthville
Ambrose School Age Care Our Lady of the Nativity Lawson
Ambrose School Age Care Our Lady Queen of Peace Greystanes
Ambrose School Age Care Our Lady of the Rosary Kellyville
Ambrose School Age Care Our Lady of the Way Emu Plains
Ambrose School Age Care Sacred Heart Mount Druitt
Ambrose School Age Care Sacred Heart Westmead
Ambrose School Age Care St Aidan's Rooty Hill
Ambrose School Age Care St Andrew's Marayong
Ambrose School Age Care St Angela's Castle Hill
Ambrose School Age Care St Anthony's Girraween
Ambrose School Age Care St Bernadette's Castle Hill
Ambrose School Age Care St Bernadette's Dundas
Ambrose School Age Care St Bernadette’s Lalor Park
Ambrose School Age Care St Canice’s Katoomba
Ambrose School Age Care St Finbar's Glenbrook
Ambrose School Age Care St Francis of Assisi Glendenning
Ambrose School Age Care St John XXlll Stanhope Gardens
Ambrose School Age Care St John's Riverstone
Ambrose School Age Care St Joseph’s Kingswood
Ambrose School Age Care St Joseph's Schofields
Ambrose School Age Care St Margaret Mary’s Merrylands
Ambrose School Age Care St Mary MacKillop South Penrith
Ambrose School Age Care St Mary's Rydalmere
Ambrose School Age Care St Matthew's Windsor
Ambrose School Age Care St Michael's Baulkham Hills
Ambrose School Age Care St Michael's Blacktown South
Ambrose School Age Care St Monica's North Parramatta
Ambrose School Age Care St Monica’s Richmond
Ambrose School Age Care St Nicholas of Myra Penrith
Ambrose School Age Care St Oliver's Harris Park
Ambrose School Age Care St Patrick's Blacktown
Ambrose School Age Care St Patrick’s Guildford
Ambrose School Age Care St Patrick’s Parramatta
Ambrose School Age Care St Paul the Apostle Winston Hills
Ambrose School Age Care St Thomas Aquinas Springwood
Ambrose School Age Care Trinity Kemps Creek
Ambrose Early Learning Holy Family Emerton
Ambrose Early Learning Mary Queen of the Family Blacktown South
Ambrose Early Learning Our Lady Queen of Peace Greystanes
Ambrose Early Learning Santa Sophia Box Hill (Gables)
Ambrose Early Learning St John XXlll Stanhope Gardens
Ambrose Early Learning St Luke's Marsden Park
I want to:
*
ADD an Emergency Contact / Authorised Nominee
REMOVE an Emergency Contact / Authorised Nominee
ADD Emergency Contact / Authorised Nominee
Name of Emergency Contact / Authorised Nominee to be added
*
First
Last
Address
*
Address Line 1
City
State / Province / Region
Postal Code
Phone
*
Relationship to Child
*
I authorise this person to be an emergency contact
*
✔️ Yes
✘ No
I authorise this person to collect this child
*
✔️ Yes
✘ No
Authorised Person's Email Address
*
An email address is required when the collection authorisation is selected
I authorise this person to authorise administration of medication, medical treatment from a registered medical practitioner, hospital or ambulance service for this child and authorise consent of this child to be transported by an ambulance service
*
✔️ Yes
✘ No
I authorise this person to authorise an educator to take the child outside the education and care service premises
*
✔️ Yes
✘ No
I authorise this person to authorise this child being transported by the service or on transportation arranged by the service
*
✔️ Yes
✘ No
REMOVE Emergency Contact / Authorised Nominee
Name of Emergency Contact / Authorised Nominee to be removed
*
First
Last
Relationship to Child
*
This person is no longer authorised as an emergency contact for this child
*
✔️ Yes
✘ No
DECLARATION
Parent / Guardian Name
*
First
Last
Email
*
Parent / Guardian Signature – please sign with mouse or finger
*
Clear Signature
Date
*
Send Form
Print
