Childcare and Early Years Service
Privacy Notice:
The Childcare and Early Years Service is registered as a ‘Controller’ under the Data Protection (Jersey) Law 2018 as we collect and process personal
information about you. We process and hold your information in order to provide public services and meet our statutory obligations. This notice
explains how we use and share your information. Information may be collected on a paper or online form, by telephone, email, or by a member of
our staff, or in some cases, by another Government department. We will continually review and update this notice to reflect changes in our services
and feedback from service users, as well as to comply with changes in the law. For more information, visit www.gov.je.
Personal Declaration Form
Personal details:
Name
Role and Responsibilities
Setting Name (if applicable)
Personal circumstances:
Since you last completed a Health Declaration Booklet or Personal Declaration form, have you…:
..been or are attending your doctor on a regular basis.
Yes
No
…been prescribed regular medication by your doctor not mentioned in previous declarations.
Yes
No
…been cautioned by or involved with the police.
Yes
No
…been cautioned or convicted by a court.
Yes
No
…had a child removed from your care by order of a court
Yes
No
…been involved with Children’s Services/MASH/ISS.
Yes
No
…been disqualified from acting as a childminder or foster parent.
Yes
No
If you have answered ‘Yes’ to any of the statements above, provide details here:
Once completed and signed, this form must be given to your manager who will review and discuss any further actions
with you.
If you are the manager of a setting or a childminder, your completed Personal Declaration form must be shared with
your Registration and Regulation Officer for review and discussion.
Your signature: Date:
Note: Giving false information or failing to disclose information is an offence under the terms of the Day Care of Children
(Jersey) Law, 2002, Article 12(d).
