Parental Consent Form (M5-D2) - International School Moshi

Parental Consent Form for M5, D1 and D2 Boarding Students
School Year 2013/2014
The Consent form is to help boarding parents make informed decisions, and should be updated each year. All privileges are at the
discretion of the boarding staff.
Please read the Boarding Handbook before completing this form.
STUDENT'S NAME: CLASS;
Please place a tick in the box of your choice:
1 The student may withdraw up to TSh____________ per week from the school bank.
YES NO
We recommend pocket money of 5,000/= to 12,000/= per week. Funds for OP trips,
11 The student may have unsupervised access to the Internet
approximately $30 to $60 per trip, may be kept in a separate account if required
under conditions specified by the school.
YES NO 12 The student may take part in trips arranged by people or
2 The student may use a taxi to and from (i) Moshi town
organisations outside the school
(ii) Arusha 13 Declaration:
(iii) Airport I authorise the boarding staff to sign permission forms for school organised
(iv) Anywhere
trips as follows
3 The student may use public buses to & from (i) Moshi town A Educational trips in Tanzania
(ii) Arusha B Educational trips beyond Tanzania
(iii) Airport C Other school trips (camping, mountain, sports) in Tanzania
(iv) Anywhere
D Other school trips (camping, mountain, sports) beyond
Tanzania
4 The school should provide transport to and from the airport at the cost
specified in the Boarding Handbook.
WEEKEND AND HOLIDAY INVITATIONS:
5 The student may accept lifts from members of the teaching staff 14 When students accept weekend or holiday invitations with other
6 The student may accept lifts from the parents or employed drivers of other
students at the discretion of the boarding staff. (i) In Moshi area
(ii) To & from Arusha
families, we cannot guarantee the degree of supervision they may
receive. You may therefore wish to communicate directly with
parents they wish to sign out to, and then confirm with us that it is
a satisfactory arrangement.
PLEASE CHECK EITHER A OR B NOT BOTH
7 The student may accept lifts from any other driver at the discretion of the
school’s administration.
MY DAUGHTER/SON CAN DRIVE WITH THE STUDENT DRIVER NAMED BELOW IF
PERMISSION IS ALSO GIVEN BY THEIR BOARDING PARENT ON EACH
OCCASION:
8 The student may visit local shops or restaurants unsupervised that are
approved by the school. They can only sign out twice between Monday
and Thursday, must be at least 3 students (The school has its own
shop, which supplies most of the students’ needs).
9 The student may visit Moshi town unsupervised as part of a boarding trip,
normally taking place on Friday afternoon or Saturday morning.
10 ONLY FOR DIPLOMA STUDENTS
The student may visit local shops or restaurants, approved by school,
unsupervised on a weekend evening at the discretion of the Boarding staff.
Trips will be a maximum of 4 hours, there must be at least 3 students and
they must return by the designated time.
(iii) Anywhere A The student may, without my specific confirmation, accept
invitations to any families of other students
(i) in Moshi
(ii) in Arusha
(iii) anywhere
B
OR……………………………………………………………
The student may only accept invitations if I have confirmed
the arrangement personally:
I would like to confirm in advance that the student may accept
invitations to the families listed here:
YES
YES
NO
NO

15. HOLIDAY ACCOMMODATION BEFORE AND AFTER TERM TIME
The school cannot offer boarding facilities to students before the start or after the end of term.
Please state what arrangements you wish us to make in the event that the student arrives before the start or departs after the end of term or during half term breaks
16. FOR ARUSHA RESIDENTS ONLY—CIRCLE ONE
My child will return home to Arusha every weekend to stay at home from Friday to Sunday. I guarantee to advise the boarding parent in advance of any weekend when my child plans to
stay in school or travel elsewhere. OR
My child will stay in school every weekend unless specifically given permission to travel elsewhere.
I have completed this parental consent form after reading and understanding the Boarding Handbook. Any changes to the information on this consent form may only be made by
the parent or guardian whose signature appears on this form
(Signature of parent/ guardian) (Date)
CONTACT INFORMATION (Parent/guardian)
PLEASE GIVE YOUR CURRENT EMAIL
ADDRESS AS REGULAR COMMUNICATION
FROM SCHOOL WILL NORMALLY BE BY
EMAIL
NAME:
ADDRESS:
LOCAL GUARDIAN
NAME:
ADDRESS:
EMERGENCY CONTACT
Where possible, please give us the name and
address of a family in the Moshi or Arusha area
who can be contacted in the event of an
emergency.
NAME:
ADDRESS:
LANDLINE:
MOBILE:
LANDLINE:
MOBILE:
LANDLINE:
MOBILE:
FAX:
Email:
FAX:
Email:
FAX:
Email: