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Parent Consent and Risk DisclosureIt is important that this Parental consent and risk disclosureform and the Health profile form are completed by all adultand student participants in the EOTC event, to comply withschool health and safety requirements.

The purpose of the forms is to enable the school to ensure that

optimal staffing levels are provided, the specific needs ofparticipants are met and the educational value and safety ofevents is maximised.

Details on these forms will remain confidential to school staff,contractors and volunteers associated with supervising activitieson the EOTC event.

For safety reasons, please provide us with information that isaccurate and complete.

Please return this form to the school by16/02/09

School/group: Balmacewen Intermediate Year 7

Room13

Details of event:

Location: Year 7 Camp - Waihola

PARTICIPANT INFORMATION FORM

Please complete these details:

Students Name:

Address: _______________________________________________

________________________________________________________

Telephone:____________

Cell Phone:____________________

Date of Birth: / /

Doctors Name:________________________________

Clinic:_______________________________________

Ph:_______________

Medical Alert number (ifapplicable)_______________________

THIS FORM OR A COPY MUST BE TAKEN ON THE EVENT. A

COPY SHOULD BE RETAINED BY THE SCHOOL.

Startdate

31ST

March2009

Time 9am Finishdate

2nd

April2009

Time 4pm

8/14/2019 Medical Form Room 13 Camp 2009 Students & Parent Helpers

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EMERGENCY CONTACT DETAILS (please provide atleast 2 sets of contact details)

1. Name (Emergency

contact)

Relationship

Address

Day

Phone

Evening

Phone

CellPhone

2. Name (Alternativeemergencycontact)

Relationship toparticipant

Address

DayPhone

EveningPhone

Cell

Phone

Parental consentI agree to my child/myself taking part in the EOTC event andhave read the information sheet. I agree to their / myparticipation in the activities described. I acknowledge theneed for them / me to behave responsibly.

Acknowledgment of riskI have read the EOTC event information sheet (can be found

on blackboard next week) and I understand that there arerisks associated with involvement in school EOTC events andthat these risks cannot be completely eliminated. Iunderstand that the school will identify any foreseeable risksor hazards and implement correct management proceduresto eliminate, isolate, or minimise those hazards. I understandthat my child has been involved in the development of safetyprocedures. I will do my best to ensure that my child and Ifollow these procedures.

I know that I am able to ask any questions of the school

about the activities I / my child will be involved in, to gain abetter understanding of the risks involved. I recognise thatparticipation in such activities is voluntary and notmandatory. My child and I both understand that I/they maywithdraw from the activity if I/they feel at risk. This must bedone in consultation with the person in charge.

I understand that the school does not accept responsibilityfor loss or damage to personal property and that it is myresponsibility to check my own insurance policy.

PrintName:_______________________________________

Signed:______________________________________

Date: / /

To be read and signed by adult participant orparent/caregiver of child participant.