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Parent Skating Trip
School Trip to Alpine Ice, Christchurch on Thursday 2nd September. All parents are welcome to attend but must make own travel arrangements. The session times at Alpine Ice are from 10.15am to 12.15am. If you wish to skate the cost is $9.50 payable by Monday 2nd August. After this date the cost will be $16 paid direct to Alpine Ice on the day.
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Parent's Name
Your answer
Doctors Name and phone number
Your answer
First Emergency Contact Details Name and Number
Your answer
Second Emergency Contact Details Name and Number
Your answer
I agree to taking part in the EOTC event and have read the information sheet . I agree to my child participating in the activities described and I acknowledge the need for them to behave responsibly.
Yes
Clear selection
I have read the RAM and understand that there is are risks associated with involvement in school EOTC events and that these risks cannot be completely eliminated. I understand that the school will identify any foreseeable risks or hazards and implement correct management procedures to eliminate, isolate or minimise those hazards.
Yes
Clear selection
I understand that the school does not accept responsibility for loss or damage to personal property and that it is my responsibility to check my own insurance.
Yes
Clear selection
Will you be skating?
Yes
No, if not skating are you happy to assist
Clear selection
Do you have any of these medical conditions?
Migraine
Epilesy
Asthma
Diabetes
Travel sickness
Chronic nose bleeds
Fits of any type
Heart conditions
Dizzy spells
Colour blindness
Other:
Clear selection
Are you taking any current medication, please state name of medication, dosage/times to be taken?
Your answer
Are you allergic to anything, ie prescription medicine, food, bites/stings and other?
Your answer
Date of last Tetanus injection?
Your answer
To the best of your knowledge, have you been in contact with any contagious or infectious diseases in the last 4 weeks?
Yes
No
Clear selection
I will inform the school asap of any changes in medical or other circumstances.
Yes
No
Clear selection
I agree to receiving any emergency medical, dental or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present
Yes
No
Maybe
Clear selection
Any medical costs not covered by ACC or a community service card will be paid by me.
Yes
Clear selection
I agree to pay the full cost of the trip by no later than Monday 2nd August.
Yes
Clear selection
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