Boarders - Somerville House

2011 boardERS’ handbook
Somerville House Boarding Routine
Activity Consent Form
STUDENT NAME
YEAR LEVEL
Activities: as per scheduled leave allowances in Boarder Handbook or any that may be arranged throughout the year.
eg. Boarders’ socials, cinema trips, ice-skating, ten pin bowling, supporting sporting girls off-campus, outside
school dances, beach trips, theme parks, recreational and environmental pursuits, health and fitness pursuits.
Please return this consent form to the Head of Boarding (Alayne McDougall) by:………………………………
Failure to return it will result in the student being refused permission to participate in the activities.
Consent Form
Head of Boarding
Somerville House
South Brisbane
I, being a parent/guardian
of
(student’s name)
1. Consent to her participation in routine activities as
per leave allowance schedule (see page 14 Boarders’
Handbook and above) under the care and supervision
of members of the Boarding Staff and/or other persons
authorised by the School.
2. Have granted/refused* our/my daughter permission to
participate in swimming/aquatic activities.
3. Acknowledge that while the School’s policy is one of
relaxed control, the rules of the School, with which
we are familiar, apply at all times, and that any breach of
those rules by our daughter, or lack of cooperation with
supervisors or fellow students on the part of our daughter,
may result in her early return from the activity at our
expense. I further understand that she is expected to
adhere strictly to all details of the planned program and to
the established mode of dress for the occasion.
4. Authorise supervisors to act on our behalf, and in
particular, where they consider necessary, to seek
medical or other treatment for our daughter, which may
include the administration of anaesthetics and/or
blood transfusions, and in respect of the cost of such
treatment we shall be liable.
5. We consent to the administration of non-prescription
medication (for example Panadol) via a staff member
where this is deemed to be necessary by the supervising
staff member or the person in charge of first-aid. (This
will not be done where staff have been advised to the
contrary).
In consideration of the foregoing and of the School
allowing our daughter to participate in the activities referred
to above:
1. We hereby agree to indemnify and keep the School
indemnified in respect of any costs or expenses
incurred by the School in connection with:
• The early return of our daughter from the activity for
disciplinary reasons;
• Medical treatment afforded to our daughter taking part
in the activity.
2. Should there be any claims, demands or proceedings
arising from our daughter’s participation in the activities
we agree to indemnify the School for:
• All excess payments on School insurance policies
covering the claim,
• All sums beyond the limit of insurance coverage held
by the School and applying to the claim.
Signature of Parent/Guardian
Date / /
SOMERVILLE HOUSE BOARDER’S VISITORS LIST
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somerville house 2011