Camp medical consent form

WebPartZone1_1

PublishingPageContent

The Department of Education, through Strathpine State School, is collecting personal information in accordance with Education (General Provisions) Act 2006 in order to maintain student medical consent records. The information will only be accessed by Department of Education. The information will not be given to any other person or agency unless consent is provided.

WebPartZone1_2

Child's last name *

Child's first name *

Class *

Date of birth *

Gender

Male

Female

Medical treatment *

Yes

In the event of an accident or illness, I authorise school staff to obtain or administer any medical assistance or treatment my child may reasonably require, including contacting my child’s doctor.

Medical or physical needs *

Yes

I have provided the school all relevant details relating to my child’s medical or physical needs on enrolment and where relevant have updated this information.

Medical costs *

Yes

I accept liability for all costs incurred in obtaining such medical assistance or treatment (including any transportation costs) and undertake to reimburse the State of Queensland (via the Department of Education) the full amount of any costs incurred on my child’s behalf.

Sleep considerations – i.e. bed wetting or sleep walking

Please detail.

Food intolerances/allergies or other allergies *

Please detail. (An emergency action plan may be required)

Special dietary requirements

Please detail.

Current prescribed medication(s) if applicable

Please detail.

Other special considerations for your child

Please detail. The school collected medical information about your child at enrolment. This information is stored on OneSchool. Please give full details of any new or changing conditions (medical, physical or management) which may affect your child’s full participation in school camp activities.

Child’s medical practitioner (optional)

Phone number of child’s medical practitioner (optional)

Medicare number *

Private health insurance company and number (if applicable)

Is this information to be added to OneSchool records?

Yes

No

If an enrolment form for your child has been completed or updated since October 2012 their medical information will be already recorded in OneSchool. I would like this additional information about my child’s medical and physical details to recorded in OneSchool records.

Activity risks insurance

Yes

The activity outlined above carries an inherent risk of physical injury occurring. Please note that the Department of Education does not have personal accident insurance cover for students. If your child is injured as a result of an accident or incident, all costs associated with the injury, including medical costs are the responsibility of the parent/carer. Some incidental medical costs may be covered by Medicare. If you have private health insurance, some costs may be also be covered by your provider. Any other costs must be covered by parents/carers. It is up to all parents/carers to decide what types and what level of private insurance they wish to arrange to cover their child. Please take this into consideration in deciding whether or not to allow your child to participate in this activity. I understand and acknowledge the above.

I understand by submitting this form I agree to all terms and conditions *

Yes

Parent/Carer name *

Date *

WebPartZone2_1

WebPartZone2_2

WebPartZone2_3

WebPartZone3_1

WebPartZone3_2

WebPartZone3_3

WebPartZone3_4

WebPartZone4_1

WebPartZone5_1

WebPartZone5_2

WebPartZone6_1

WebPartZone6_2

WebPartZone7_1

WebPartZone7_2

WebPartZone8_1

WebPartZone8_2