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SETS consent form end of year party

Consent Form

Student Date of Birth

First and last name

Full address (i.e. 10 Happy Street, Labrador, 4215)

Gender
Female
Male
Other

Parent/guardian full name

Parent/guardian contact number

Student Date of Birth

Emergency contact name & relationship

Emergency contact phone number

Today's date

Medical Information

Does the student have any of the following medical conditions?
Heart problems
Respiratory (e.g. asthma)
Diabetes
Blood pressure
Recent operations
Epilepsy
Back, bone, joint problems
None of the above

Has the student had the tetanus booster?

Please detail any other medical or physical probems which would limit the student's full participation.

In the event of an accident or illness, I authorize staff to obtain or administer any medical assistance or treatment my child may reasonably require, including contacting my child's doctor.
Yes
No
I have provided the all relevant details relating to my child's medical or physical needs on enrolment and where relevant have updated this information.
Yes
No
I give permission for my child to ride in the MCCGC bus to and from Logan for the tournament.
Yes
No

Photo Permission

I give permission to the Multicultural Communities Council Gold Coast Ltd (MCCGC) to use photos that have been taken of my child during Ready, Set, Goal activities. The photos will be used for the purpose of promotion and will continue to be used unless MCCGC is advised otherwise. I understand the photos can be used in any appropriate MCCGC publications, which include newsletters, flyers, brochures, the MCCGC website and MCCGC presentations.
YES, I give permission for my child's photo to be used
NO, I do not give permission for my child's photos to be used
MCCGC