Page 1 of 2

Essential information record

This cover note verifies that the essential information record for the child/young person named below has been discussed and read by the carer.

By signing below, you confirm that you are the carer of the child/young person to whom this essential information record relates, and that you have read, agreed to, and received a copy of this Record.

Child/young person's name

How many carers are signing?

Full legal name

Applicant 1

Signature