PARENT INFORMATION AND CONSENT FORM
FOR SCHOOL EXCURSION

Dear Parent / Caregiver,

I am pleased to provide you with the following details regarding our excursion to

on

This excursion has been planned to supplement the following work being completed in your son’s/daughter’s classroom:

The cost of the excursion is $

The class will depart from Anzac Terrace PS at

and return to	at

Travel will be by

Number of students attending excursion

Members of the supervisory team are:

The staff member with CPR and/or first aid training is

Activities to be undertaken:

Special clothing or other items required:

Contact arrangements during the excursion:

Class Teacher

Date:

PARENT CONSENT for EXCURSION

(Please detach and return by )

I consent to _____________________ (your child’s name) participating in an excursion to

on

If your son/daughter has special needs please provide full details and include any relevant medical details on the attached Student Health Care Summary.

If the proposed excursion poses any additional health risks to those identified in the Student Health Care Summary, e.g. if your child suffers from anaphylaxis there may be risks associated with the provision of meals and storage of an adrenaline auto injector at the appropriate temperature. Please outline additional health risks below:

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

I give permission for my son/daughter to receive medical treatment in case of emergency.

I am aware that the school and its employees are not responsible for personal injuries or property damage which may occur on an excursion, unless the school or its employees are proven to be negligent.

___________________________	_______________

Parent / Caregiver	Date