Mernda PS Parental/Guardian Authorisation and Consent Form
Your permission is for the duration of your child's time at Mernda Primary School
I give consent for:
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Student Name
To be inspected for head lice by selected school staff and/or Council Nurses
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Yes
No
To have band aids applied when necessary
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Yes
No
To take part in supervised local walking excursions in and around Mernda including Interschool Sport
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Yes
No
To view selected DVD's rated PG and educational resources online related to classroom programs
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Yes
No
Throughout the year our school uses photographs of students or samples of their work in the school newsletter and on our website e.g. pictures of children working in class or in activities: these pictures can be used in brochures or flyers and occasionally in the general media. Parental consent is required for this.
For the following consent:
I give consent to my child’s photographs to be published within the Physical School Environment. In Classrooms, Display Boards in the school grounds
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Yes
No
I give consent to my child’s photographs to be published within the School Community. On password protected school based platforms such as the Firefly portal
*
Yes
No
I give consent to my child’s photographs to be published beyond the School Community Publicly. To ALL online media including, school newsletter, on social media, on the School's Website and other Marketing Materials
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Yes
No
In the event of illness or injury to my child whilst at school, on an excursion, or travelling to or from school and the Principal or a staff member is unable to contact me, or it is otherwise impracticable to contact me, I authorise the Principal and or staff member of my child, to administer first aid when needed.
Consent to my child receiving such medical or surgical attention as may be deemed necessary by a medical practitioner
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Yes
No
Administer such first aid as the Principal or staff member may judge to be reasonably necessary
*
Yes
No
I certify that the information contained withing this form is correct.
Please enter parent/guardian name:
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Relationship to child
*
Signature
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Date
*
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: