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Stage 3 Hockey Gala Day
This Term 4 Stage 3 will be participating in a hockey gala day at North Narrabeen Reserve.

Please submit this form no later than Friday 2 November 2018.

IMPORTANT: Please complete and submit individual forms for each child

Wednesday 7th November - Years 5 & 6

North Narrabeen Reserve

9:30am - 2pm

Students must wear their sports uniform

Morning tea and lunch is to be brought by the children from home and no glass bottles of any kind are allowed. Drinks may be brought in plastic containers. Sunscreen should be applied before leaving home and packed in bags.


Children that require ventolin are asked to keep their ventolin with them at all times throughout the gala day. Parents are asked to ensure their child's name is clearly marked on the ventolin

Student - SURNAME *
Please enter your surname
Your answer
Student - FIRST NAME *
Please enter your child's first name
Your answer
I give permission for my child to participate in Term 4 Hockey Gala Day 7th November *
Please select your child's class *
I understand my child participating in the gala day will be walking to and from the venue *
I am able to assist at the excursion *
Emergency contact on the day - name *
Parent / carer name
Your answer
Emergency contact on the day - mobile / telephone *
Parent / carer mobile or telephone number
Your answer
Ventolin - my child will require their ventolin with them during the event *
Medical Information
Does your child have any medical condition or disability that may affect your child's participation in the excursion? If yes, please provide information below
Your answer
Is your child on any prescribed medication(s) which would be required to be continued during the excursion? If yes, please provide name of medication, dosage and time to be taken
Your answer
Request to Administer Medication
If your child requires medication on the excursion, have you provided the school office with a completed Request to Administer Medication form signed by the prescribing doctor?
Does your child have any allergies (e.g. insect bites, food)
If yes, please provide details below
Your answer
Is there any other information you would like to give which , in your view, may affect your child's participation in the excursion?
If yes, please provide information below
Your answer
Name of parent /carer giving permission for their child to attend excursion *
Your answer
Email address of parent / carer *
Your answer
Date *
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