izabela.orkisz@kids-co.

pl
Bank Millenium 52 1160 2202 0000 0004 7628 2187
 FOOD ALLERGIES CHARTER

Child’s name:..............................................................................................................................................

PESEL number:…………………………………………………………………………………………..

The Child is allergic to:..............................................................................................................................

Item What products should be eliminated from What should replace the eliminated
number the menu? products?

1.

2.

3.

4.

5.

6.

7.

The date of the charter admission: Date and signature of the Parent/Guardian

……………..………………..……………… ……….…....................................................

1
 Food Allergies Charter
Obligation of disclosing the rules for the processing of personal data

1. The administrator of personal data (also referred to as "Data") is Centrum Rozwoju Dziecka Sp. z o.o. Limited Liability
Company seated in Warsaw (00-867), Chłodna 51 Street.
2. Personal data will be processed to the extent necessary to perform the Nursery Services/Preschool Education Services
Agreement ("Agreement") in accordance with art. 6 par. 1 letter b GDPR, in order to protect the vital interests of Child in
accordance with art. 6 par. 1 letter d GDPR and implementation of the legally justified interest of the Administrator
(Article 6 (1) letter f of GDPR).
3. Providing your personal data regarding existing allergies is necessary to avoid Child’s health problems. Providing other
data (e.g. regarding other food preferences) is voluntary.
4. The recipients of the above personal data are entities servicing the Administrator in the field of technical service,
including IT and legal, and catering companies.
5. Personal data of Parents/Guardians and Child will be processed for the duration of the Agreement, and after its expiry
for a period of 5 years in accordance with Article. 6 par. 1 letter f GDPR. Personal data of the Authorized Persons will be
processed for the duration of the Agreement, and after its expiry, will be permanently deleted.
6. You have the right to:
a) access to the Data and obtainment of a free copy thereof,
b) requesting correction or supplementing of incorrect Data,
c) request to remove or limit the processing of Data,
d) submission of a complaint to the supervisory body: President of the Office for Personal Data Protection, Stawki 2
Street, 00-193 Warszawa - if it is determined that the Data is being processed contrary to the law.
7. All petitions, questions and requests related to the processing of Data should be directed to the following address:
Centrum Rozwoju Dziecka Sp. z o.o. Limited Liability Company, Chłodna 51 Street, 00-867 Warszawa. E-mail address:
ochronadanychosobowych@kids-co.pl.
I hereby declare that I have read the above „Obligation of Disclosing the rules for the processing of personal data” and
agree to the processing of personal data contained in the Food Allergies Charter according to its content.

……………………………………………………………………………………………………………
Date and Parent’s/Guardian’s Signature

2
 Attachment number 2 to Agreement

INFORMATION SHEET

Child’s Data:
Name ..........................................................................................................................................................

Date of birth............................................ PESEL Number .............................................................................

Address of permanent residence..................................................................................................................

Address of residence (if different than permanent residence).......................................................................

Does the child have a disability status? YES / NO ( mark appropriate)

Does the child have siblings and at what age? ………………………………………………………………………………………………...

Information about the child's health status …………………………………………………………………………………………..………...

………………………………………………………………………………………………………………………………………………………………………….

Parents’/Guardians’ Data:
Mother / Guardian 1 Father/ Guardian 2

Name: ............................................................... ..............................................................

Date of birth*: ...............................................................
PESEL/Passport*: ...............................................................
Occupation: ...............................................................
Place of work: ...............................................................
...............................................................
Telephone number: ...............................................................
Mobile: ...............................................................
Business phone ...............................................................
number: ...............................................................
E-mail: ...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................
...............................................................

*For parents of children in the nursery who will be applying for 400+ funding.
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 Attachment number 2 to Agreement

Data of Persons Authorized to Pick Up the Child:

The two first letters and the

Name two last numbers of the Mobile
ID/passport

ACCIDENT AND EMERGENCY PROCEDURES

In case of emergency, injured or ill child will be taken to hospital by an ambulance, or, if their condition enable them,
they will wait for the authorized person to pick them up. If you wish your child to be taken to a specific hospital, please,
provide its name and the address below:

…………………………………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………………………………….

I agree that the teaching staff will take possible actions in the event of a threat to my child’s state of health, such as:
calling a doctor, an ambulance, or taking my child to hospital
YES*) NO *)

*) please, circle your choice

....................................................
Date and Parent’s/Guardian’s Signature

2
 Attachment number 2 to Agreement

Information Sheet
Obligation of disclosing the rules for the processing of personal data

1. The administrator of personal data (also referred to as "Data") is Centrum Rozwoju Dziecka Sp. z o. o. Limited Liability Company seated in Warsaw (00-867),
Chłodna 51 Street.

2. Personal data will be processed to the extent necessary to perform the Nursery Services/ Preschool Eduaction Services Agreement ("Agreement") in accordance
with art. 6 par. 1 letter b GDPR, in order to protect the vital interests of the child in accordance with art. 6 par. 1 letter d GDPR and implementation of the legally
justified interest of the Administrator (Article 6 (1) letter f of GDPR).

3. The recipients of the above personal data are entities servicing the Administrator in the field of technical service, including IT and legal, public entities to whom
personal data are made available under applicable law and health care entities (in accordance with the procedure "Accident and Emergency Procedures").

4. Personal data of Parents/Guardians and Child will be processed for the duration of the Agreement, and after its expiry for a period of 5 years in accordance with
Article. 6 par. 1 letter f GDPR. Personal data of the Authorized Persons will be processed for the duration of the Agreement, and after its expiry, will be permanently
deleted.

5. You have the right to:

a) access to Data and receipt of a free copy thereof,
b) requesting correction or supplementing of incorrect Data,
c) request to remove or limit the processing of Data,
d) Data transfer - by receiving Data from the Administrator in a format enabling their transfer to a selected third party,
e) submission of a complaint to the supervisory body: President of the Office for Personal Data Protection, Stawki 2 Street, 00-193 Warszawa - if it is determined
that Data is being processed contrary to the law.

6. All petitions, questions and requests related to the processing of Data should be directed to the following address: Centrum Rozwoju Dziecka Sp. z o. o. Limited
Liability Company, Chłodna 51 Street, 00-867 Warszawa. E-mail address: ochronadanychosobowych@kids-co.pl.

I hereby declare that I have read the above „Obligation of disclosing the rules for the processing of personal data” and agree to the processing of personal data
contained in the Information Sheet according to its content.

……………………….……………………………………………………
Date and Parent’s/Guardian’s Signature