[go: up one dir, main page]
Scribd
Upload
15 views2 pages

Concent

This document is a Parental Excursion/Sport Consent Form that must be completed by a parent or legal guardian for a learner participating in an excursion. It includes sections for learner details, school information, excursion specifics, and parental consent, outlining the responsibilities and risks involved. The form also requires contact information and a signature from the parent or guardian, ensuring they are informed and agree to the terms of the excursion.

Uploaded by

izaanduplessis794
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
15 views2 pages

Concent

This document is a Parental Excursion/Sport Consent Form that must be completed by a parent or legal guardian for a learner participating in an excursion. It includes sections for learner details, school information, excursion specifics, and parental consent, outlining the responsibilities and risks involved. The form also requires contact information and a signature from the parent or guardian, ensuring they are informed and agree to the terms of the excursion.

Uploaded by

izaanduplessis794
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

SCHEDULE 3: PARENTAL EXCURSION / SPORT CONSENT FORM

NOTE: This form to be completed by a parent legal guardian / person acting in parental capacity of the learner who will
be undertaking an excursion.

1. Detail of learner
1.1 NAME
1.2 GRADE
1.3 SCHOOL

2. Details of school
2.1 DISTRICT
2.2 NAME OF SCHOOL
2.3 SCHOOL EMIS NUMBER
2.4 NAME OF PRINCIPAL

3. Details of excursion
3.1 DESTINATION
3.2 PURPOSE OF EXCURSION
3.3 PROPOSED DEPARTURE DATE
3.4 PROPOSED ARRIVAL DATE

4. Consent by parent / legal guardian / person acting in parental capacity

I, ___________________________________________________ (parent / legal guardian / acting in parental capacity) do hereby


consent to the above learner undertaking the excursion, and confirm that I:

4.1 Have been advised and fully understand, the purpose, nature and risks associated with the excursion;
4.2 Have been informed by the school of all the relevant details associated with this excursion, including the itinerary,
arrangements for travel, accommodation, contact details of the excursion manager and other associated details
4.3 Understand that in the event of accident or injury to the above learner that all reasonable steps will be taken by the
excursion manager to contact me to obtain my consent for any necessary emergency medical treatment and/or any
emergency medical operation. In the event that the excursion manager is unable to contact me in such circumstances, I
authorize the excursion manager to consent to any such treatment or operation on my behalf.
RELATIONSHIP
NAME OF PERSON CONTACT DETAILS
TO THE LEARNER
HOME:
WORK:
CELLPHONE:
EMAIL:
RELATIONSHIP
NAME OF PERSON CONTACT DETAILS
TO THE LEARNER
HOME:
WORK:
CELLPHONE:
EMAIL:
4.4 Have been provided with a copy of the school’s discipline and safety rules in terms of which the learner will undertake the
Excursion / Sport event.
4.5 I accept that all reasonable precautions will be taken to ensure the safety and welfare of my child and that I shall be held
responsible for the payment of medical and/or hospital accounts, where applicable, should an injury be sustained which
cannot be ascribed to negligence on the part of the staff responsible.
4.6 I cede my powers as parent/guardian to the Principal of the school or his representative should medical treatment/surgery be
deemed necessary for my child. As far as I know he/she is in good health.
4.7 However, the persons responsible should please note the following: (Please state aspects that the teaching staff should be
aware of, e.g. allergies, tendency towards abnormal bleeding, epilepsy, etc.)

5. Details and signature of parent / legal guardian / person acting in parental capacity.

5.1
NAME
5.2
CAPACITY
5.3
ADDRESS
5.4 a)CONTACT TELEPHONE AND
b)CELL NUMBERS

5.5 Signature

5.6 Date

PLEASE ENSURE THAT ALL CONTACT DETAILS ARE VALID SO THAT WE CAN GET HOLD OF YOU IN CASE OF AN
EMERGENCY.
PARENT SIGNATURE

You might also like