Corinda State High School – Year 11 Camp QCCC Mapleton

13 July 2015

Dear Parent/Carer,

In Term 4 this year, Year 11 students are invited to attend a five day camp at QCCC Mapleton from Monday 23rd – Friday 27th November. The aim of the camp is to develop leadership qualities, assist students in their personal growth, and to build cohesive cohort relationships and friendships to ensure students are prepared for their Year 12 experience as school leaders. The camp focuses on enhancing self-esteem, working within a supportive group framework and on developing skills associated with a variety of physical activities. These activities enable students to interact, develop social skills and problem solve in a safe, supervised challenging environment.

Activity details / QCCC Mapleton
Monday 23rd – Friday 27th November (Week 8, Term 4)
What the students will be doing / Students will be taking part in a variety of outdoor activities that can include:
Archery, Leap of Faith, Giant Swing, Flying Fox, Canoeing, Climbing Wall, Orienteering, Abseiling, Bush Walking, and Facilitated Leadership Activities
Where the students will be / Students will be based at the Outdoor Centre and taking part in the activities in the surrounding area and lake.
Any potential hazards (if required) / There is a risk with all activities that could cause serious harm if the proper safety briefings and instructions are not followed.
The camp venue follows a strict safety protocol and minimises all potential hazards.
What the students will be using / Students will be using archery equipment, canoes, climbing harnesses and safety gear, compasses, GPS and maps.
Inherent risk level of the activity / High
The activity will be led by / Each activity will have no more than 20 students and will be led by experienced leaders from the centre as well as a Corinda SHS teacher present.
Transportation / Air conditioned, seat-belt equipped charter buses
Any precautions to be taken / Students will be required to wear a suitable hat, use sunscreen for all outdoor activities, water bottle – an equipment list will follow
Dress code e.g. list suitable clothing to be worn, appropriate to the activity / Day activities - Comfortable shorts, long t-shirts with sleeves, running shoes, raincoat (activities continue if wet weather) – clothing must be suitable for safety harnesses.
Night Activities: Shirts with sleeves, comfortable shorts/pants, and enclosed shoes at all times in all areas of the facility. No singlets, tank tops
Any information relevant to students with medical requirements (e.g. due to conditions such as diabetes, asthma, travel sickness, allergies or anaphylaxis). / Please complete the medical form and return with permission slip. Parents must complete medical form and record medication requirements, including asthma medication such as Ventolin and Panadol etc.

Activity Costs:

The cost of Year 11 Camp for 2015 is $430.00. This covers all transport, accommodation, meals, activities and professionally trained staff for the five days. This year, students are invited to make regular payments until Friday, 23rd October. These amounts are at your discretion, however the following minimum amounts are due on or before these dates.

·  Deposit and confirmation of attendance ($100): Due on or before Friday 21st August (Week 6, Term 3)

·  Other amounts may be deposited at your convenience: Any time between deposit and final payment date

·  Final Payment of balance : Due on or before Friday 23rd October (Week 3, Term 4)

It should be noted that the first compulsory payment of $100 is non-refundable and will guarantee and confirm your son/daughter’s attendance on camp. We allow these payment dates to break up the cost and make it easier on all parties involved. Corinda State High School must make non-refundable financial commitments to secure camp and transport bookings.

For your child to be a part of this exceptional and memorable experience, please complete the attached consent form and medical form with your first payment on or before Friday 21st August. Any special dietary requirements (religious, medical etc.) should be detailed in the attached forms (with the student’s name and form class clearly stated).

For further information about the activity, please contact Miss Rebekah Judd at or on (07) 3379 0269

Yours sincerely,

Helen Jamieson Rebekah Judd

Principal Year 11 Coordinator


Privacy Notice

The Department of Education and Training is collecting the personal information requested in this form in order to:

- obtain lawful consent for your child to participate in the activity;

- help coordinate the activity;

- respond to any injury or medical condition that may arise during, or as a result of the activity; and

- update school records were necessary.

The information will only be accessed by authorised school staff and will be dealt with in accordance with the confidentiality requirements of s.426 of the Education (General Provisions) Act 2006 (Qld) and the Information Privacy Act 2009 (Qld).

The information will not be disclosed to any other person or agency unless it is for a purpose stated above, the disclosure is authorised or required by law, or you have given DET permission for the information to be disclosed.

Activity Risks & Insurance

The activity outlined above carries an inherent risk of physical injury occurring. Please note that the Department of Education and Training does not have personal accident insurance cover for students.

If your child is injured as a result of an accident or incident, all costs associated with the injury, including medical costs are the responsibility of the parent/carer. Some incidental medical costs may be covered by Medicare. If you have private health insurance, some costs may be also be covered by your provider. Any other costs must be covered by parents/carers. It is up to all parents/carers to decide what types and what level of private insurance they wish to arrange to cover their child.

Please take this into consideration in deciding whether or not to allow your child to participate in this activity.

Consent

Please complete the required information and check all appropriate boxes below to indicate your agreement/consent:

I have read all of the information contained in this form in relation to the activity (including any attached material) and I am aware that the Department of Education and Training does not have personal accident insurance cover for students.

I give consent for my child, ______(print child’s name) in class ______(print class details), to participate in the activity detailed above.

I agree to pay to the school the costs detailed four weeks prior to my child’s participation in the activity.

In the event of an accident or illness, I authorise school staff to obtain or administer any medical assistance or treatment my child may reasonably require.

I accept liability for all costs incurred in obtaining such medical assistance or treatment (including any transportation costs) and undertake to reimburse the State of Queensland (via the Department of Education and Training) the full amount of any costs incurred on my child’s behalf.

Parent/Carer Name: ______(Please Print)

Parent/Carer's Signature: ______Date: ______/______/______

Please give full details of any problems, either medical or physical, which may affect your child’s full participation in the activity:

______

Excursion Payment Advice

Excursion/Activity: Year 11 Camp – QCCC Mapleton Date: 23rd – 27th November 2015

Department: ...... Cost: $430 (total)

Student’s Name: ...... Form Class: ......

For credit card payments (OUR PREFERRED METHOD OF PAYMENT) please complete the information below and return to the Cashier for processing. Please debit my credit card for the amount of: $

Name (Please Print)………………………………………………………..…………………… Signature……………………….……………………………………..……

Mastercard / Visa / EXPIRY DATE / -
CARD NUMBER / - / - / -

Year 11 Camp – Medical Information Update Record

student name: / Date of Birth:
Medicare Number :
Is there any medical or psychological reason to prevent your child from participating in any of the activities outlined in the Excursion Letter? If yes, give details.
medical practitioner
name of family doctor
address
phone
Medical details
heart problems / Y N
respiratory problems e.g. asthma / Y N
allergies / Y N
travel sickness / Y N
blood pressure / Y N
operations / Y N
epilepsy / Y N
recent illnesses / Y N
injections and when e.g. tetanus / Y N
drug reactions / Y N
phobias / Y N
Swimming ability / Good Fair Poor
other information
DIETARY REQUIREMENTS
Emergency Contact Details
EMERGENCY CONTACT : / PHONE :
ADDRESS :
Current Prescribed Medication(s)
The medication(s) listed below has/have been prescribed for my son/daughter by a registered medical practitioner and will be required to be administered while my child is involved in the excursion indicated on this form. I hereby request the teacher accompanying the excursion who has been authorised by the Principal to administer the medication(s) in accordance with the instructions written on the medication container(s) by the pharmacist in accordance with the medical practitioner’s instructions. I understand that all unused medication(s) will be returned to me.
SIGNATURE OF PARENT / GUARDIAN :
PRINTED NAME : / date :
Medication(s) list
Please rule an oblique line through any unused spaces below
NAME OF MEDICATION / QUANTITY OF MEDICATION / TIMES FOR ADMINISTRATION