Fill in and leave where your carer can see it
This is a general template, not legal advice. Employment law and minimum wages change. Check the current rules with the Department of Employment and Labour (labour.gov.za) or the CCMA before you sign, and change the wording to suit your situation.
| Our home address (to give to emergency services) | |
| Parent or guardian 1: name and cellphone | |
| Parent or guardian 2: name and cellphone | |
| Trusted neighbour or family member | |
| Ambulance / emergency number | |
| Family doctor | |
| Nearest hospital or clinic | |
| Medical aid name and number | |
| Armed response or security company |
| Name | Date of birth | Allergies | Medicine and dose |
|---|---|---|---|
| Time | What happens |
|---|---|
| Wake up | |
| Breakfast | |
| School drop-off | |
| Morning nap | |
| Lunch | |
| Afternoon nap | |
| School pick-up | |
| Homework or activities | |
| Supper | |
| Bath and bedtime |
Food and snacks allowed:
Screen time:
Who may collect the children or visit:
Alarm, gate and keys:
Pets:
Template provided by KhayaKin · khayakin.co.za