Consent & Disclosure E-Form

[NB: Each parent or legal guardian must sign and return a copy of this form.] I understand that [insert name of service] (the Service) will collect my child or legal ward’s (as identified below) (Child) personal information. Personal information (including information or an opinion) may include information that I provide (or someone provides on my behalf) as part of my Child’s enrolment application or as part of an application for funding for my Child or otherwise in connection with the Child’s attendance at the Service, including the Child’s name, date of birth, and sensitive information such as information relating to the Child’s health including any disability (this may include medical records and reports) (Personal Information). I authorise the Service to disclose my Child’s Personal Information to the New South Wales Department of Education and Communities (Department). I understand that the Department will only use or disclose such Personal Information relating to the Child as permitted under applicable privacy laws including the Privacy and Personal Information Protection Act 1998 (NSW). In limited circumstances this may include disclosure to other Australian government agencies, including the Commonwealth and to those located in States and Territories outside New South Wales. The Department may use my Child’s Personal Information for any purpose relating to the exercise of its governmental functions including for, but not limited to, the assessment and potential provision of support or funding to my child or the Service including for any teachers or caregivers in connection with the Service. If you do not agree to your Child’s Personal Information being provided to the Department then this could impact the funding allocation made available to the Service. Under law, you may have a right of access to, and correction of, such Personal Information. Please contact the Service or the Department in such circumstances.