The following permission note is to be completed by each family each calendar year.
Please read and complete the following permission note and return it to the school immediately.
Caregiver's Name : ................................................ Phone No. ............................. Mobile No. .............................
Postal Address : ..................................................................................................... Medicare No. ...............................
Residential Address : ...................................................................................................................................................
Name of child : ..................................... Class : ............ Name of child : ................................. Class : ...............
Name of child : ..................................... Class : ............ Name of child : ................................. Class : ...............
Name of child : ..................................... Class : ............ Name of child : ................................. Class : ...............
Yes No
Go swimming for Swimming Carnivals, Sport, Sport Days and other events at the Wee Waa pool, ( ) ( )sporting fields etc. (Students will be supervised by qualified CPR and Emergency Care staff)
To attend Local Excursions and Sporting Events fully supervised around town, which may or may not ( ) ( )
involve travel by bus.
To take part in the Child Protection unit of Personal Development, Health and Physical Education ( ) ( )
To take part in the Drug Education unit which applies to my child/children ( ) ( )
To have photographs of my child/children included in the local newspapers and/or school newsletters, ( ) ( )
website
The Community Health team to screen and if necessary, contact me about my child/children, as the need ( ) ( )
arises, for head lice/school sores or any other contagious condition
(Any permission not given for the last item will result in the child being excluded from school until home treatment has been completed).
Signature of Parent/Guardian : ...................................................................... Date : .......................
Yours sincerely,
Susan Smith,
Relieving Principal.
Please complete the relevant information below :
Student's Medical Conditions.
Yes No
Name : .................................................................. Medical / Allergies ( ) ( )
Details : ......................................................................................................................................................................
...................................................................................................................................................................................
Yes No
Name : .................................................................. Medical / Allergies ( ) ( )
Details : ......................................................................................................................................................................
...................................................................................................................................................................................
Yes No
Name : .................................................................. Medical / Allergies ( ) ( )
Details : ......................................................................................................................................................................
...................................................................................................................................................................................
Yes No
Name : .................................................................. Medical / Allergies ( ) ( )
Details : ......................................................................................................................................................................
...................................................................................................................................................................................
Yes No
Name : .................................................................. Medical / Allergies ( ) ( )
Details : ......................................................................................................................................................................
...................................................................................................................................................................................
Yes No
Name : .................................................................. Medical / Allergies ( ) ( )
Details : ......................................................................................................................................................................
...................................................................................................................................................................................
The personal information provided on this form is being obtained for the purpose of processing the student's general permission notes. It will be used by the Department of Education and Training for general student administration and communication and other matters relating to the education and welfare of the student. While the provision of this information is voluntary, if you do not provide all or any of this information it may delay or prevent the processing of this application. This information will be stored securely. You may access or correct any personal information provided by contacting the school.