Consent Form for Yrs PP - 2 In-term Swimming 2014 – Please fill in both sections fully

To be returned signed to the school by Friday 14th November

Contact Information:

Student Name: / Room:
 Home: /  Work: / Mobile:

I have read & understood the information regarding the In-term Swimming lessons at Craigie Leisure Centre and give my consent for my son / daughter to participate.

I have enclosed $47 to cover the cost of the bus transport

or

I have paid $47 to Hillarys PS by direct debit on______(date)

Account details

ANZ Whitfords BSB 016 494 Account 3408 43493 Reference Student’s full name & class

Signature of parent / guardian: ______Date: ____/____/2014

Note:

Staff accompanying students on excursions will take all reasonable care while the students are in their charge to protect them from injury and to control and supervise their behaviour and activities. Parents/guardians should be aware that staff members are not responsible for injuries or damage to property which may occur on an excursion where, in all circumstances, staff have not been negligent.

In the case of excursions not involving an overnight stay, costs incurred as a result of accident or illness are the responsibility of the parent/guardian.

Parents are required to inform the organisers well before the scheduled excursion departure of any change to their child’s health and fitness so that appropriate supervision may be arranged. Where it is considered necessary, school staff will arrange medical assessment and treatment for students.

______

INTERM SWIMMING ENROLMENT FORM – Hillarys PS

TO BE COMPLETED BY PARENT:

I give my child ______Room_____ permission to attend In-term swimming.

(PRINT FULL NAMECLEARLY IN NEAT BLOCK LETTERS)

Age: ______Parent Contact Phone/s: ______

Is your child subject to asthma, seizures, fainting, epilepsy, diabetes, allergies or any other conditionthat may affect his/her safety?

NoYes. Please list and provide specific details of medication currently being taken if applicable.

______

Unless such conditions are listed and the form returned, Swimming Staff can not take responsibility for medical conditions of which they are unaware.

Stage No:
1. Beginner
2. Water/Surf Discovery
3. Preliminary
4. Water/ Surf Introduction
5. Water/Surf Safe
6. Junior / 7. Intermediate
8. Water/Surf Wise
9. Senior
10. Jnr Swim & Survive
11. Swim & Survive
12. Snr Swim & Survive
12+ Adv Swim & Survive /
MY CHILD IS GOING FOR STAGE NO:

Unsure, please grade
My child has attempted this ‘going for’
stage three times in Department of
Education & Training classes
without passing
I agree to inform the organisers before the scheduled departure of any change to my child’s health and fitness. Where it is not practical to
communicate with me, I authorise the school teachers to consent to my child receiving such medical treatment as may be considered necessary.
Signature ______Date ____/____/2014 / My child is going for Stage No:

(Parent/Guardian)