St Joseph's Swim Program Term 4

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Our Swim Program will commence in Term 4 for all Kindergarten, Year 1 and Year 2 students at Terrey Hills Swim School.

Please submit this form no later than Monday 16th September.

IMPORTANT: Please complete and submit individual forms for each child

WHEN: Commencing Thursday 17th October 2019 to Thursday 12th December 2019 (excluding 28 November)

WHERE: Terrey Hills Swim School

UNIFORM: Students must wear their sports uniform including shoes and socks. They may wear swimmers under their uniform or they can bring swimmers to school to change into.

WHAT TO BRING:
Swimming costume
Goggles
Swim cap
Towel
T-shirt
Sandals

Students will travel to and from the venue by bus. The bus will leave St Joseph's at 11am and return to school at 1pm.

Student - SURNAME *

Please enter your child's surname

Student - FIRST NAME *

Please enter your child's first name (separate form for each child please)

Class *

Kindergarten

Year 1

Year 2

I give permission for my child to attend the Terrey Hills Swim School Swim Program *

Yes

I give permission for my child to travel to and from the venue by bus *

Yes

Please tick one box that best describes your child's swimming ability *

Non-swimmer i.e. cannot glide with face in water

Needs stroke correction

Can swim 25m of each stroke competently

Attends lessons at Terrey Hills Swim School

Medical Information

Does your child have any medical condition or disability that may affect your child's participation in the swim program? If yes, please provide information below

Medication

Is your child on any prescribed medication(s) which would be required to be taken whilst at the Swim Program? If yes, please provide name of medication, dosage and time to be taken. Note: Medication held at school for individual children (ventolin/Epipen) will be taken by school staff to the pool.

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 your child's treating doctor?

Yes

Clear selection

Does your child have any allergies (e.g. insect bites, food)

If yes, please provide details below

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

Name of parent /carer giving permission for their child to attend excursion *

Email address of parent / carer *

Emergency contact information - name of contact on the day *

Emergency contact information - mobile/telephone number on the day *

Date *

YYYY

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