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Change of family details and authorisations form

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This form should be completed whenever your family or authorisation details change.

Family details and authorisations form

Educator details

Scheme name (required)

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Family details

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

What information would you like to change?

Name change

Old title (required)

Old title other

New title (required)

New title other

New first name (required)

New last name (required)

Please contact your scheme office to discuss your name change process and requirements.

Email change

You must provide the email address already registered with the Business and Customer Support Centre. It’s likely to be the email address you provided as part of the enrolment process. If you no longer have access to this email account and you now want to update your email address, please contact the Business and Customer Support Centre to verify your identity.

Old email (required)

For example – jane.doe@gmail.com

New email (required)

For example – jane.doe@gmail.com

Mobile number change

Old mobile number (required)

for example – 0412 543 876

New mobile number (required)

for example – 0412 345 678

Address change

New postal address line 1 (required)

For example – 123 Flinders Ave

New postal suburb (required)

For example – Adelaide

New postal postcode (required)

For example – 5000

Emergency contacts authorisation

Add or remove authorisation to be contacted in the event of an emergency if you cannot be immediately contacted.

An emergency contact is a friend or relative who can be contacted in case of an emergency if you are not contactable.

Are you adding emergency contacts

yes

no

Number of emergency contacts to add

Adding details of emergency contacts

Adult 1

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 2

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 3

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 4

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Comments

Are you removing emergency contacts

yes

no

Number of emergency contacts you are removing

Details of emergency contacts you are removing

Adult 1

First name (required)

Last name (required)

Adult 2

First name (required)

Last name (required)

Adult 3

First name (required)

Last name (required)

Adult 4

First name (required)

Last name (required)

Comments

Drop-off and collection authorisation

Add or remove authorisation to drop off and collect your child or children on your behalf.

If any of your contacts don't have a mobile phone or email address, please use your details.

Are you adding drop-off and collection contacts

yes

no

Number of drop-off and collection contacts to add

Adding details of drop-off and collection contacts

Adult 1

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 2

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 3

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 4

First name (required)

Last name (required)

Email (required)

For example – jane.doe@gmail.com

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Comments

Are you removing drop-off and collection contacts

yes

no

Number of drop-off and collection contacts you are removing

Details of drop-off and collection contacts you are removing

Adult 1

First name (required)

Last name (required)

Adult 2

First name (required)

Last name (required)

Adult 3

First name (required)

Last name (required)

Adult 4

First name (required)

Last name (required)

Comments

Consent for medical treatment or administer medication authorisation

Add or remove authorisation to consent to medical treatment and authorise administration of medication to your child or children on your behalf.

Are you adding consent for medical treatment or administer medication authorisation contacts

yes

no

Number of medical consent contacts to add

Adding details of medical consent contacts

Adult 1

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 2

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 3

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 4

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Comments

Are you removing consent for medical treatment or administer medication authorisation contacts

yes

no

Number of medical consent contacts you are removing

Details of medical consent contacts you are removing

Adult 1

First name (required)

Last name (required)

Adult 2

First name (required)

Last name (required)

Adult 3

First name (required)

Last name (required)

Adult 4

First name (required)

Last name (required)

Comments

Consent for excursions with your educator or educator assistant authorisation

Add or remove authorisation to consent for your child or children to be taken outside the education and care service premises with your educator.

Are you adding excursion consent contacts

yes

no

Number of excursion consent contacts to add

Adding details of excursion consent contacts

Adult 1

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 2

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 3

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Adult 4

First name (required)

Last name (required)

Mobile number (required)

For example – 0412 345 678

Address line 1 (required)

For example – 123 Flinders Ave

Suburb (required)

For example – Adelaide

Postcode (required)

For example – 5000

Comments

Are you removing excursion consent contacts

yes

no

Number of excursion consent contacts you are removing

Details of excursion consent contacts you are removing

Adult 1

First name (required)

Last name (required)

Adult 2

First name (required)

Last name (required)

Adult 3

First name (required)

Last name (required)

Adult 4

First name (required)

Last name (required)

Comments

Parent or carer acknowledgement

Acknowledgement statement

By submitting this form, you:

confirm that you are the authorised person to update the details above for your child or children
declare all information to be true and correct on 5 October 2022.

Acknowledgement statement (required)

yes

Leave this field blank

Contact

Family Day Care BCSC

Phone (metro): 8343 6533
Phone (country): 1300 551 890
Email: educationfdcbusiness [at] sa.gov.au

Central group of schemes main office

Phone: 8416 7400
Email: education.centralfdc [at] sa.gov.au

North group of schemes main office

Phone: 8207 9100
Email: education.northfdc [at] sa.gov.au

South group of schemes main office

Phone: 8207 3657
Email: education.southfdc [at] sa.gov.au

South Australia

Department for Education

Change of family details and authorisations form

Family details and authorisations form

What information would you like to change?

Parent or carer acknowledgement

Contact

Family Day Care BCSC

Central group of schemes main office

North group of schemes main office

South group of schemes main office

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