Common use of Custodial Statement Clause in Contracts

Custodial Statement. Are there any custodial arrangements concerning your child? Yes □ No □ If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Please note: if you are naming the Father or Mother of the child we cannot prevent them from collecting or visiting unless we have a custody order on file. Name: Name: Relationship to the child: Relationship to the child: Date of Enrolment: Date of Entry: Date of Exit: Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total number of hours: Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. 20 Hours ECE at this service Total number of hours: 20 Hours ECE at another service Total number of hours: Parent/Guardian Signature: Date: / / Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick One Yes No Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the above, please sign to confirm that:

Custodial Statement. Are there any custodial arrangements concerning your child? Yes □ No □ If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Please note: if you are naming the Father or Mother of the child we cannot prevent them from collecting or visiting unless we have a custody order on file. Name: Name: Relationship to the child: Relationship to the child: Date of Enrolment: Date of Entry: Date of Exit: Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total number of hours: Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. 20 Hours ECE at this service Total number of hours: 20 Hours ECE at another service Total number of hours: Parent/Guardian Signature: Date: / / Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick Select One Yes No Is your child receiving 20 Hours ECE at any other services? Tick Select One Yes No If yes to either or both of the above, please sign to confirm that:

Custodial Statement. Are there any custodial arrangements concerning your child? Yes □ No □ If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Please note: if you are naming the Father or Mother of the child we cannot prevent them from collecting or visiting unless we have a custody order on file. Name: Name: Relationship to the child: Relationship to the child: Date of Enrolment: Date of Entry: Date of Exit: Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total number of hours: Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. 20 Hours ECE at this service Total number of hours: 20 Hours ECE at another service Total number of hours: Parent/Guardian SignatureTotal number of hours: Date: / / Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? No No Tick One Yes No Is your child receiving 20 Hours ECE at any other services? Tick One Yes No If yes to either or both of the above, please sign to confirm that:

Custodial Statement. Are there any custodial arrangements concerning your child? Yes □  No □  If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Please note: if you are naming the Father or Mother of the child we cannot prevent them from collecting or visiting unless we have a custody order on file. Name: Name: Relationship to the child: Relationship to the child: Date of Enrolment: Date of Entry: Date of Exit: Days Enrolled: Monday Tuesday Wednesday Thursday Friday Times Enrolled: Total number of hours: Please Note: 20 Hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. 20 Hours ECE at this service Total number of hours: 20 Hours ECE at another service Total number of hours: Parent/Guardian Signature: Date: / / Is your child receiving 20 Hours ECE for up to six hours per day, 20 hours per week at this service? Tick One Yes  No  Is your child receiving 20 Hours ECE at any other services? Tick One Yes  No  If yes to either or both of the above, please sign to confirm that: