Y5 Camp Permissions Form

Year 5 Camp Permissions Form
Dear Parents,

As part of the planning and preparation for Year 5 Camp, we need to gather information to ensure all travel, medical and safety considerations are met.
1. If your child's medical information is out of date, please update and complete the following form:
  Student Medical Profile
2. If your family contact information has changed, update them here:
  Student Contact Details Change Form
Student Information
Student Name*

First NameLast Name
Class*
Medical and Dietary Information
Please identify medications you permit a school nurse to administer, if required:

Acetaminophen/paracetamol (panadol)Throat Lozenges (strepsil)Anti-histamines (piriton)Anti-histamines (zyrtec)Rehydration solutionIbuprofen (nurofen)None of the above
Details of other medication that need to be administered on camp.
Does your child have any dietary restrictions?
Other information
I confirm that my child has an up-to-date tetanus vaccination.*

Yes
I have reviewed my child's medical information and emergency contact information and: *

I confirm that the information currently held at DBIS is correct.I have completed the medical and/or contact change forms.
Permissions
I give permission for my child to participate in the Year 5 Trip.*
I acknowledge the need for my child to behave maturely and responsibly and will brief them accordingly prior to departure. *
I understand that by completing this form, I am fully responsible to pay the full trip costs and understand that this payment is non-refundable. *
Parent Name*

PrefixFirst NameLast Name
Parent E-mail*
Date of Submission*

DayMonthYear
Should be Empty:

Year 5 Camp Permissions Form

Student Information

Medical and Dietary Information

Permissions