2023 Year 6 Camp (Collaroy Centre)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dear Parents and Carers,

To help us prepare for the upcoming Year 6 Camp at The Collaroy Centre in Collaroy in Week 9 (13th to 15th September), we ask you to please complete the below Google Form. The form allows us to collate all relevant medical information about your son, which will assist us in the planning process.

It is important that you also ensure your son's medical information is up-to-date on the College's TASS student system.

If your son requires medication while he is on camp, this must be supplied by parents in the original container, clearly marked with the student's name, the name of the drug, dosage, frequency of administration and prescribing doctor's name.

If you have any further questions, please contact Ms Sanchez to discuss on 9387 5022. All medication needs to be delivered to Ms Samara Sanchez by Monday 11 September.

Son's Full Name (First and Last) *

Son's Date of Birth *

YYYY

Son's Class *

6 Blue

6 Gold

6 Indigo

6 Orange

6 Red

6 White

Full Name of Parent Guardian *

Home Address *

Telephone Number (Home, Work and Mobile) *

Son's Medicare Number (incase of serious accident) *

Son's Medicare Reference Number *

Son's Medicare Expiry Date *

YYYY

Emergency Contact #1 (Full Name) *

Emergency Contact #1 Relationship to your son? *

Emergency Contact #1 Contact Number *

Emergency Contact #2 (Full Name) *

Emergency Contact #2 Relationship to your son? *

Emergency Contact #2 Contact Number *

MEDICATIONS - My son needs to be given the following medication: Breakfast - Amount/ Lunch - Amount/ Dinner - Amount

When was your son's last tetanus booster shot? *

YYYY

Does your son suffer from any of the following? *

Asthma

Drug Allergies

Other Allergies (including food)

Anaesthetic (local and general) Allergies

Epilepsy

Diabetes

Muscular problems (Eg. back problems, knee problems, poor eyesight etc.)

Phobias/ fears of any kind

Recent operations/ injuries

Other (please list in below question)

N/A

Required

If you clicked any of the following above, please give full details (For example - Severity, Medication, Date of Attack, Operation, Injury).

If your son has any confidential concerns (eg. bed wetting, sleep walking etc. please list them below or you're welcome to contact your son's class teacher or both Dawn Young and Alex McCredie (Junior School Psychologist's).

Please carefully read before completing the last three questions. I, (Name) being the parent or legal guardian of the above mentioned student assume full responsibility for his health. I will also notify Waverley College Junior School of any significant change in the participant's health prior to any camp or excursion. I declare that all statements on the form are true and accurate and that all relevant information has been provided. *

Yes, I agree to above statement

Full Name (Parent Guardian) *

Date of Form Completion *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Waverley College. Report Abuse

Forms