JC 2019 Year 6 Canberra Trip Permission & Emerg. Cont./Dietary/Medical Form

JC 2019 Year 6 Canberra Trip

Parental Permission and Student Emergency Contact/Dietary/Medical Form

Student Activity Information Form

ACTIVITY

Year 6 Canberra Trip

PERSONS IN CHARGE

Paul Baker and Allison Busiko

DATE OF ACTIVITY

Monday 16 September to Friday 20 September 2019

VENUES

Brisbane, Canberra, Cooma and Smiggins

DEPARTURE VENUE & TIME

Arrive at Hume Street Campus by 5.00am for a 5.30am departure on Monday 16 September 2019

RETURNING TIME & VENUE

Approximately 4.00pm on Friday 20 September 2019 at Hume Street Campus

Endorsed by

~ Please submit this form by Monday 12 August 2019 ~

PARENT PERMISSION &

STUDENT EMERGENCY CONTACT/DIETARY/MEDICAL FORM

Student's First Name*

Student's Surname*

Campus*

I acknowledge that my child, will be participating in the JC 2019 Year 6 Canberra Trip on Monday 16 September 2019 to Friday 20 September 2019.*

Yes

I agree to delegate my authority to the teachers involved. Such teachers may take action they deem necessary to ensure the safety, wellbeing and successful conduct of the students as a group or individually during the trip.*

Yes

I authorise and appoint the Head of College or his staff as my agent to use an ambulance and/or obtain medical assistance that may be needed, including anaesthetics and blood transfusions. It is agreed that any expenses incurred will be my responsibility.*

Yes

I agree to pay all costs should my child have to be transported home for any reason.*

Yes

REQUIRED STUDENT INFORMATION:

Relevant Dietary Information (if none, type n/a)*

Medicare Number*

Position on Card*

Expiry Date MM/YYYY*

Student's Date of Birth DD/MM/YYYY*

Student's Address*

Student's Doctor: Name, Address and Phone Number*

Relevant Medical Information (if none, type n/a)*

Medication (other than Panadol) If your child requires medication on the Year 6 Canberra Trip, it must be clearly marked with the Child's Name and Doctor/Pharmacist's instructions on the label. This includes both prescription and over the counter medication. I authorise the teachers to administer medication to my child according to the Doctor/Pharmacist's Instructions on the label of my child's medication.*

Yes

PLEASE NOTE: We are unable to administer the first dose of any new medication to your child (ie, medication which the child has never taken before). All medication needs to be handed in before departure and will be administered by teachers according to directions.

Panadol: My child can be administered Panadol for pain relief medication if required. (Panadol will be supplied by the College)

YesNo

Best Parent Contact Phone Number 1*

Best Parent Contact Phone Number 2*

Parent / Guardian Signature*

Date*

Date

Parent /Guardian Signature please type in your First Name and Surname.

Confirmation Email*

Confirmation Email - This will allow us to return the details you have submitted by reply email for your convenience.

* Required Field