Add Emergency Contact Form

About the Add Emergency Contact Form

A digital emergency contact form that allows parents to add or update emergency contacts and authorised persons on their child's enrolment record. Under Regulation 160, enrolment records must include emergency contact details, authorised nominees, and persons authorised for medical treatment, medication, transportation, and collection. This form captures all required contact details and specific authorisations including emergency contact, pickup, medical consent, transportation, and regular outing permissions.

Also called

Emergency contact form
Authorised nominee form
Emergency contact details form
Childcare emergency contact form

What's on this form

Every question included in the add emergency contact form. Add, remove or reword any of them in the form builder.

Form questions

Children
List all children this form applies to.
Contact Details
First Name
First Name of Contact
Last Name
Last Name of Contact
Mobile Number
Mobile
Relationship to Child
Relationship of Contact
Address
Address of Contact
Do you authorise for this contact to be contacted in the case of an emergency where we are unable to reach a parent / guardian?
Yes / No
Do you authorise for this contact to be added to your Authorised Pick-Up List, which allows them to sign your child in and out of our service at any time, without the need for authorisation?
Yes / No
Can this person be contacted to give consent for educators to transport the child or arrange transportation of the child?
Yes / No
Can this person be contacted to give consent for medical treatment or to authorise for a nominated supervisor or educator to administer medication to the child in the event that you cannot be contacted?
Yes / No
Can this person be contacted to give consent for educators to take the child outside the service's premises in the event that you cannot be contacted?
Yes / No
Can this person be contacted to give consent to the transportation of the child by an ambulance service?
Yes / No
Can this person give authorisation for the service to take the child on regular outings?
Yes / No
Parent/Guardian Signature
Signature

Australian regulations this form supports

The add emergency contact form is built around the Education and Care Services National Regulations. These are the regulations it helps you meet.

Reg 160

Child enrolment records to be kept by approved provider and family day care educator

Enrolment records must include emergency contacts, authorised nominees, and persons authorised for medical treatment, medication, transportation, and collection.

Read the full text of Reg 160

(1) The approved provider of an education and care service must ensure that an enrolment record is kept that includes the information set out in subregulation (3) for each child enrolled at the education and care service. (2) A family day care educator must keep an enrolment record that includes the information set out in subregulation (3) for each child educated and cared for by the educator. (3) An enrolment record must include the following information for each child— (a) the full name, date of birth and address of the child; (b) the name, address and contact details of— (i) each known parent of the child; and (ii) any person who is to be notified of an emergency involving the child if any parent of the child cannot be immediately contacted; and (iii) any person who is an authorised nominee; and (iv) any person who is authorised to consent to medical treatment of, or to authorise administration of medication to, the child; and (v) any person who is authorised to authorise an educator to take the child outside the education and care service premises; and (vi) any person who is authorised to authorise the education and care service to transport the child or arrange transportation of the child; (c) details of any court orders, parenting orders or parenting plans provided to the approved provider relating to powers, duties, responsibilities or authorities of any person in relation to the child or access to the child; (d) details of any other court orders provided to the approved provider relating to the child's residence or the child's contact with a parent or other person; (e) the gender of the child; (f) the language used in the child's home; (g) the cultural background of the child and, if applicable, the child's parents; (h) any special considerations for the child, for example any cultural, religious or dietary requirements or additional needs; (i) the relevant authorisations set out in regulation 161; (j) the relevant health information set out in regulation 162.

Reg 161

Authorisations to be kept in enrolment record

The enrolment record must contain authorisations signed by a parent for medical treatment, ambulance transportation, and regular outings or transportation.

Read the full text of Reg 161

(1) The authorisations to be kept in the enrolment record for each child enrolled at an education and care service are— (a) an authorisation, signed by a parent or a person named in the enrolment record as authorised to consent to the medical treatment of the child, for the approved provider, a nominated supervisor or an educator to seek— (i) medical treatment for the child from a registered medical practitioner, hospital or ambulance service; and (ii) transportation of the child by an ambulance service; and (b) if relevant, an authorisation given under regulation 102 for the education and care service to take the child on regular outings; and (c) if relevant, an authorisation given under regulation 102D(4) for regular transportation of the child. (2) The authorisations to be kept in the enrolment record for each child educated and cared for by a family day care educator are— (a) an authorisation, signed by a parent or a person named in the enrolment record as authorised to consent to the medical treatment of the child, for the family day care educator to seek— (i) medical treatment for the child from a registered medical practitioner, hospital or ambulance service; and (ii) transportation of the child by an ambulance service; and (b) if relevant, an authorisation given under regulation 102 for the family day care educator to take the child on regular outings; and (c) if relevant, an authorisation given under regulation 102D(4) for regular transportation of the child.

Reg 99

Children leaving the education and care service premises

A child must not leave the premises unless given into the care of a parent or authorised person, or leaving in accordance with written authorisation.

Read the full text of Reg 99

(1) The approved provider of an education and care service must ensure that a child who is being educated and cared for by the education and care service does not leave the education and care service premises except in accordance with subregulation (4). (2) A nominated supervisor of an education and care service must ensure that a child who is being educated and cared for by the education and care service does not leave the education and care service premises except in accordance with subregulation (4). (3) A family day care educator must ensure that a child who is being educated and cared for by the educator as part of a family day care service does not leave the residence or approved family day care venue except in accordance with subregulation (4). (4) The child may only leave the relevant premises if the child— (a) is given into the care of— (i) a parent of the child; or (ii) an authorised nominee named in the child's enrolment record; or (iii) a person authorised by a parent or authorised nominee named in the child's enrolment record to collect the child from the premises; or (b) leaves the premises in accordance with the written authorisation of the child's parent or authorised nominee named in the child's enrolment record; or (c) is taken on an excursion in accordance with this Division; or (ca) is transported by the service or on transportation arranged by the service in accordance with Division 7; or (d) is given into the care of a person or taken outside the premises— (i) because the child requires medical, hospital or ambulance care or treatment; or (ii) because of another emergency. (5) In this regulation parent does not include a parent who is prohibited by a court order from having contact with the child.

Provided for information only and may not reflect the latest amendments. Refer to the Education and Care Services National Regulations (NSW) for the official legal text.

Where this form fits

The add emergency contact form is part of these jobs — each guide walks through the whole sequence and the other forms that go with it.

Enrolling a child: the forms you need

The enrolment record itself, plus the booking, emergency contacts, medical conditions and standing authorisations that go with it.

Forms parents and guardians fill in

Every form you send out to families — enrolment, permissions, collection arrangements, medication authority and feedback.

Questions about the add emergency contact form

What is the add emergency contact form used for?

Who fills in the add emergency contact form?

The add emergency contact form is completed by a parent or guardian. You send them a secure link by email or SMS — they don't need an account, an app, or a password to fill it in and sign.

Which Australian regulations does the add emergency contact form meet?

It is built around Reg 160, Reg 161 and Reg 99 of the Education and Care Services National Regulations. Reg 160 covers child enrolment records to be kept. Reg 161 covers authorisations to be kept in enrolment record. Reg 99 covers children leaving the education and care service premises. Every question the regulations require is already on the form.

Is the add emergency contact form the same as an emergency contact form?

Yes. Different services use different names for this form — it is also called emergency contact form, authorised nominee form, emergency contact details form and childcare emergency contact form. They all describe the same record, and this template covers it. You can rename it to whatever your service already calls it.

Can I change the questions on the add emergency contact form?

Yes. The template comes with 15 fields ready to go, but you can add, remove, reword or reorder anything in the drag-and-drop form builder, and add your own conditional logic and signing steps. Your changes only affect your service's copy.

Is the add emergency contact form free?

Yes — the add emergency contact form is free to use on the Childcare Forms free plan. No credit card is required to create an account and start sending it.