Year 8 Camp Letter - The Southport School

MEDICAL AND DIET REQUIREMENTS
FOR OUTDOOR EDUCATION CAMP
(RETURN TO Mr. Humbley,
c/ T.S.S., Southport; Fax (07) 5531 9977)
STUDENT NAME:
HOUSE:
DOES YOUR SON HAVE ANY SPECIAL DIETARY REQUIREMENTS? (PLEASE DETAIL)
DOES YOUR SON HAVE ANY MEDICAL CONDITIONS OF WHICH ‘FIRST AID’ STAFF SHOULD BE
AWARE? (PLEASE DETAIL)
DO YOU CONSENT TO NON PRESCRIPTION MEDICATIONS BEING ADMINISTERED TO YOUR
CHILD AS REQUIRED? (I.e. panadol)
(MUST CIRCLE ONE) YES / NO
PLEASE LIST ANY REGULAR MEDICATIONS THAT YOUR SON REQUIRES, AND ITS DOSAGE.
WOULD YOU DESCRIBE YOUR SONS SWIMMING ABILITY AS:
UNABLE LIMITED GOOD 50m EXCELLENT 100m
IN THE EVENT OF AN EMERGENCY ON CAMP, PLEASE PROVIDE THE FOLLOWING DETAILS.
EMERGENCY CONTACT PERSON 1. 2.
EMERGENCY PHONE NUMBER 1. 2.
PARENT NAME
SIGNATURE
DATE