Year 3 and 4 Camp Consent 2017

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This form includes overall camp consent, emergency contact, medical and dietary information.

Student's name (including surname): *

I give consent for my child to attend the Year 3 and 4 Palm Grove camp. *

Yes, I want my child to attend the Year 3/4 camp.

No, I do not want my child to attend this camp. My child will stay at school on these days.

Please tick all appropriate options below regarding your child's medical conditions.

If you tick any of the options below, please give further details in the next question.

My child has no medical conditions

Asthma

Heart condition

Bed wetting

Sleep walking

Bus sickness

Sinus difficulties

Dizzy spells or blackouts

Migraines

Hayfever

Other:

If your child has any medical conditions, please give further details.

Please tell us of any medication your child will / may need to take.

Be as specific as possible about times, quantities etc.

Do we have permission to give your child Pamol (pain relief for children) at an age-appropriate dosage, if necessary? *

Pamol will only be administered if needed and recommended by a teacher. If consent is not given on this form, we will endeavour to contact you for permisssion if required. If permission is not given, we will not administer Pamol to your child.

Yes, permission is given to administer Pamol if required.

No, permission for Pamol to be administered is not given.

Please tell us of any particular dietary requirements your child has.

For example any food they cannot eat for medical or religious reasons.

Please fill in daytime and/or mobile phone numbers for two parents or caregivers. *

Please fill in an additional emergency contact name, relationship to child and home and/or mobile phone number. *

This contact should not be a parent or caregiver and may be used in the event that a parent or caregiver cannot be contacted.

Please indicate if you would like to be part of the camp as additional parental help (any adults staying over will be required to undergo Police Vet checks) *

Yes, I would like to attend the camp as additional help

No, I will not be attending the camp as additional adult support.

If you would like to attend the camp and have additional comments about this, please add them below.

If you have any further information about your child, please add it below.

Please consider the activities we will be doing and the fact that this is a camp away from home. The more information we have about your child, the more we can support them and meet their needs to ensure they have a great camp.

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