Protection of Personal Information Act 4 of 2013. This is the centre's own record. It is not a government form.
Centre: Phone:
Address:
Information Officer: Cell: Email:
| Child's full name | Date of birth |
| Class or group | Date of enrolment |
| Parent or guardian full name | ID number |
| Relationship to child | Cell number |
We ask for the parent's ID number for the subsidy means test and to confirm who is signing. If your centre claims no subsidy, leave it out.
| What we hold | Why we hold it |
|---|---|
| Name, date of birth, birth certificate number | Enrolment, age group placement, subsidy claim |
| Home address, home language, emergency contacts | Daily care, safe collection, reaching you quickly |
| Medical notes, allergies, medication, immunisation | Keeping your child safe and treating an emergency |
| Daily attendance record | Register and the subsidy claim, paid per day attended |
| Fee account and payment history | Billing and the centre's financial records |
Shared with: the district education department, a clinic in an emergency, and our bookkeeper. Sold to nobody.
Kept for: years after your child leaves, then destroyed. Fee and payment records are kept years, because company and tax law require longer. Ask your bookkeeper for the period that applies.
Your rights: ask us what we hold, have it corrected, or withdraw this consent in writing at any time. Withdrawal does not undo processing that was lawful before you withdrew.
I am the parent or legal guardian of the child named above and I am legally entitled to give this consent for that child. I have read this page. I agree to the centre holding and using this information for the reasons written next to it. Where both parents share parental responsibility, both should sign.
You may tick NO on any line. Your child takes part in every activity either way. No child is left out for a NO.
| The centre may use photographs or video of my child in this way | YES | NO |
|---|---|---|
| Displayed inside the centre and in my child's own portfolio | ||
| Sent in the closed parent WhatsApp group for this class | ||
| Posted on the centre's Facebook page or website | ||
| Printed in flyers, posters or the centre's brochure | ||
| Included in a report to the district office or a funder | ||
| My child's first name may appear next to the photograph |
Consent withdrawn on: (leave blank at signing)