PARENT INFORMATION AND CONSENT FORM

FOR SCHOOL EXCURSION

INSTRUCTIONS

Parent/guardians need to provide informed consent for the excursion including:

 relevant medical information relating to their child; and a
 signed consent form returned to the school by 01/10/2018

Dear Parent/Guardian

At J3 Primary School we recognise excursions provide opportunities for children to

engage and explore the wider community as a group. In doing so children are actively
participating in their education using different resources to enhance and enrich their
learning.

I am pleased to provide you with the following details regarding our excursion to
Cicerello’s Fremantle on 08/10/2018.

This excursion has been planned to supplement the following work being undertaken in
your child’s classroom:

The natural resources provided by the environment and different views on how
they can be used sustainably.

The cost of the excursion is $13.20/child.

The class will depart from school at 9.00am and return to school at 1.00pm and we will
be travelling by bus.

The supervisory team are:

Mr Jonathon Marsh

Mr Jason Duval

Mr Jayson Radicevic
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Parent/Care Giver Helpers:

- As with most excursions the volunteering of time to help and provide assistance
to teachers by parents and care givers (helpers) is of great value.

- The supervisory team have assessed the activities and the venue and
determined that four (4) helpers are required for this excursion.

- The helpers have been chosen to assist teachers with appropriate and effective
supervision of the children for the duration of the excursion and planned
activities.

Activities to be undertaken:

- Indoor aquarium viewing tour

- The opportunity to see and touch a crayfish and Port Jackson Shark

- Outdoor Beach Combing Activity

- Topics to be discussed include marine pollution, sustainable fishing practices and

ways to help reduce human impact on the environment

Special clothing or other items required:

- school uniform

- school hat

- water bottle

- sunscreen will be provided however, if your child has a sensitivity concern please
provide your own

Contact arrangements during the excursion:

If you need to contact your child or a member of the supervisory team during the
excursion please contact the school in the first instance on 9XXX XXXX.

Excursions Procedures
All policy and procedural statements contained within this document are lawful orders for the purposes of section 80(a) of the Public
Sector Management Act 1994 (WA) and are therefore to be observed by all Department of Education employees.
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Consent Form – please sign and return to school by 01/10/2018

If your child has special needs please provide full details and include any relevant
medical details in the space below.

If the proposed excursion poses any additional health risks to those identified below e.g.
if your child suffers from anaphylaxis there may be risks associated with the provision of
meals and storage of an adrenaline auto injector at the appropriate temperature.

Please outline additional health risks below:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

I consent to _________________________________ participating in an excursion to

Cicerello’s Fremantle on 08/10/2018.

I give permission for my child to receive medical treatment in case of emergency.

I am aware that the school and its employees are not responsible for personal injuries
or property damage which may occur on an excursion, unless the school or its
employees are proven to be negligent.

_______________________ ________________________________
Parent/guardian Date

PAYMENT

Payment of $13.20/child can be made in one of the following ways;

BPay – BSB XXX XXX Account Number XX-XXX-XXX

Cash or Credit Card – please attend the front office during business hours, 8.00am-
4.00pm

Excursions Procedures
All policy and procedural statements contained within this document are lawful orders for the purposes of section 80(a) of the Public
Sector Management Act 1994 (WA) and are therefore to be observed by all Department of Education employees.