ABEC Preservice Teacher Emergency Contact Details

PROJECT PARTNERSHIPS
COLLEGE OF EDUCATION
PO BOX 14428 MELBOURNE
VICTORIA 8001 AUSTRALIA
PHONE +61 3 9919 7591
FAX
+61 39919 7574
[email protected]
BACHELOR OF EDUCATION (EARLY CHILDHOOD-PRIMARY)
PRESERVICE TEACHER EMERGENCY CONTACT DETAILS
Preservice teachers are to complete and submit this form to their Mentor Teacher
Name of Preservice Teacher
________________________________________________
Student ID
________________________________________________
Emergency Contact Name
________________________________________________
Relationship
________________________________________________
Emergency Contact Home Phone
________________________________________________
Emergency Contact Home Mobile
________________________________________________
Emergency Contact Phone at Work
________________________________________________
MEDICAL CONDITION/S (including allergies, medications, treatment required if incident occurs)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Preservice teachers are to ensure that the contact nominated above has agreed to being
contacted in the case of an emergency and that the details provided are current. The
preservice teacher is to notify the setting Coordinator if any details above change.
Privacy: School/Setting Partnerships Coordinators/mentor Teachers are to ensure these forms are kept in a
secure and confidential location and that personal health details are only communicated to relevant personnel
in the event of an emergency.