BeresfieldPublic School

Telephone: 4966 1146 Fax: 4966 2492

PARENT/GUARDIAN INFORMATION & CONSENT FORM

U12’S Rugby League Knock Out Quarter Final

Thursday 9thAugust2012

Dear Parent /Guardian,

Your child has been selected to represent Beresfield Public School in Open Rugby League at Lindsay Oval, Beresfield on Wednesday15th August 2012 playing against Valley View Public School in the Quarter Finals of the Classic Shield Cup. The team will progress to the Semi Finals if they win.

Cancellations of excursions due to weather will be advised on the school website as soon as a decision is made.

Students will depart from school at 9:00am ready to begin playing at 10:00am. Year 5 students will walk to and from Lindsay Oval with Miss Jones. Year 6 students will also walk with Miss Jones to the game but after the game the Year 6 students will travel by private car to Francis Greenway High School for their transition day.

The staff member with emergency care training and CPR training is Miss Jones.

Parents please note there is no personal injury insurance cover provided by the NSW Department of Education and Training for students in relation to school sporting activities, physical education lessons or any other school activity. Parents and Caregivers are advised to assess the level and extent of their child’s involvement in the sport program offered by the school, zone, area and state school sports association when deciding whether additional insurance cover, above that provided by Medicare, is required. The NSW Supplementary Sporting Injuries Benefits Scheme, funded by the NSW Government, covers any injury resulting in the permanent loss of a prescribed faculty or the use of some prescribed part of the body.

Additional Information: Due to regulations, your current driver’s licence and registration papers need to be sighted if parents / community members transport students. Please present these at the office so they can be copied. All children must be seat belted.

Jacqui Jones – Sport Coordinator Jonathan Ridgway - Principal

----------Please detach and return to Miss Jones byTuesday 14thAugust, 2012 ------

U12’S Rugby League Knock Out Quarter Final

I do consent to of

(Full Name)(Class)

representingBeresfield Public School in Rugby League at Lindsay Oval, Beresfield on Wednesday 15th August 2012.

My son has the following special needs (please provide full details and include any relevant medical details)

To the best of my knowledge he/she has no medical condition, physical disability or injury, which puts him/her at risk in participation in the sport.

Please circle: I give / do not give permission for my child to receive medical treatment in case of emergency.

Year 6: I give permission for my child to be transported by private vehicle from Lindsay Oval to FGHS.

Year 6: I can / can’t help with transport on this day.

In addition to my child I can take another ______children.

Drivers Name:

Signature of Parent/Guardian Date