Bronze Duke Edinburgh Lake Moke Trip, 23-25 November 2023

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Moke Lake Bronze Duke of Edinburgh Qualifying Journey
Dates: Thursday 23 November 3.30pm – Saturday 25 November 5pm
Transport: SGHS Hostel Van depart from SGHS Carpark 3.30pm and return to car park at SGHS 5pm
Gear List: Click HERE for the list. Students may bring cell phones to take photos and contact home when close to Invercargill.
Cost: $150.00. Students will need have access to money for tea on Thursday night in Queenstown and some spending money if they wish to bring that as well. Payment, permission and health form needs to be completed by Friday 17 November 2023.
Accommodation: Thursday Night – staying at Lakeland Christian Camp, Friday night at Moke Lake Department of Conservation site in tents.
Staff attending: Sue Mattingly, John Grogan, Morgan Hunter and a father are accompanying the students.

This event contains risks, including certain risks being an outdoors activity. This event is run by school staff who will manage risk and hazards according to the school’s safety management plan. This includes careful planning to mitigate as many risks as practical and to have safety equipment and first aid kit as appropriate to the event. Risks include possible trips or falls along steep ground and exposure to bad weather. This will be mitigated by careful route selection by staff with previous experience on this journey, and ensuring correct clothing is always worn. While risks can be maintained to acceptable levels they cannot be totally eliminated. Some risk is retained for its learning and experiential value. If you wish to come in to school to see our safety
management systems or have any questions, feel free to contact Sue Mattingly if you have any questions or concerns.

It is important for safety reasons that students follow instructions given to them by all staff and follow all appropriate school rules. Behaviour by students that is deemed dangerous and puts themselves and/or others at undue risk will result in parents being contacting and if necessary, parents would need to come and get their child at the parents’ expense.

Please feel free to contact me at school with any queries 027 2286 111.

"*" indicates required fields

Student Information:

The information on this form will remain confidential to the teachers/instructors in charge of/assisting with the camp/trip. However, in the interests of the safety of all involved, any life-threatening conditions may be made known to other students. Please be assured that your child’s physical and emotional well-being always remains of paramount importance to us.

Student's Full Name*

First Last

Students Date of Birth*

DD slash MM slash YYYY

Student Mobile

Home Phone

Students Medical Information:*

I give permission for this information to be shared with the teacher in charge as required.

Yes (Medical)

No (Medical)

Medical Conditions

Migraine

Diabetes

Chronic Nose Bleeds

Colour Blindness

Sleep Talking

Epilepsy

Travel Sickness

Heart Condition

Anaphylaxis

Bedwetting

Asthma

Seizures of any type

Dizzy Spells

Sleepwalking

Home Sickness

Medication

If your child is taking any prescribed medication please list below

Medication NOT to be taken

Is there any medication your child is NOT able to be given?

Major Breaks/llnesses

Has your child had any major injuries (breaks or strains) or illness (Glandular fever etc) that may limit full participation in any activities? (If Yes, please complete in the box provided below).

Allergies

If your child has any allergies please list below

Can your child confidently swim 20 metres?

Yes

Unsure

Special Access Arrangements

Visual Concerns

Mobility Issues

Hearing Issues

Other

Dietary Requirements

Outline any special dietary requirements. Please be specific, eg: vegetarian, lactose intolerant, etc

Transport*

Please indicate below if you give permission for your child to be driven by named staff members attending. (If you have any queries in relation to this please contact the Teacher in Charge of the trip).

Yes, I give permission (Transport)

No, I don't give permission (Transport)

Other Information

Is there any other information that your child's teacher or staff should know to ensure the physical and emotional safety of your child. eg: cultural practices, anxiety, phobia about heights or small spaces, etc

Parent/Caregiver Consent:

Please tick the boxes below to complete the Parent/Caregiver consent.

Parent Consent*

I give my child permission to participate in Lake Moke Bronze Duke of Edinburgh Trip

My child has read and understands the Student Code of Conduct.

My child's medical information is up to date with Student Services

I acknowledge the school policy that states you must 'pay before play/attend' an event/trip or sport.

I acknowledge that full payment is required by the due date specified for my child to be eligible to participate in this event.

I acknowledge that any payments made to my child's account will be allocated to the oldest unpaid fees/charges if any and that my child is not able to participate until all these charges are paid in full.

I acknowledge and accept the Risks Disclosure.

I agree that my child is responsible for managing the taking of her prescribed medication. They are willing and able to manage the medication without direct supervision. A designated adult will hold/carry the medication for safekeeping. The prescribed medication must be clearly labelled and securely fastened. A set of detailed and clearly written instructions must be included.

I am willing and able to pick up my child if they develop any signs of sickness during the event/activity. eg: Covid

I will inform the school as soon as possible of any changes in the medical or other circumstances between now and the commencement of the event

I agree to my child receiving any emergency medical treatment as considered necessary by the medical authorities present.

Any medical costs not covered by ACC or a community service card will be paid by me.

Parent/Caregivers First Name*

Parent/Caregivers Last Name

Parent/Caregivers Email*

Parent/Caregivers Mobile*

Parent/Caregiver Signature*

Payer Details

Payer Name*

First Last

Payer Email*

Please enter a valid email address to receive a emailed version of this form once completed.

Payer Mobile*

Payment

Any payments received for your child will be allocated to the oldest unpaid amounts sitting on your child's account first. Your child is not able to participate until all these amounts are paid in full.

Bronze Duke Edinburgh Lake Moke Trip

Price:

Total

Payment Options*

Pay Online now by Debit / Credit Card

Cash / Eftpos at Student Services

Automatic Payments (AP)

Bank Transfer

Student Information:

Parent/Caregiver Consent:

Payer Details

Payment

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