Student Health Form Level 2 Cycling Trip to Alexandra

Please only complete this form if your child is registered for the Level 2 Cycling trip to Alexandra:

If you have any questions regarding this form please contact the Teacher in Charge, Mr Dave Beadle; [email protected]

  • 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.
  • Please tick if your child suffers from any of the following:
  • Is your child currently taking any medication?
  • Please state the following in the box below: Ailment(s) / Name of Medication / Dosage and Time(s) to be taken / Other Treatment
  • 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).
  • Is your child allergic to any of the following?
  • Please specify severity and treatment below:
  • Outline any special dietary requirements. Please be specific, eg. vegetarian, lactose intolerant etc.
  • Is there any medication your child is NOT able to be given?
  • To the best of your knowledge, has your child been in contact with any infectious diseases in the last four weeks? If yes, please detail below:
  • Is there any information that your child's teacher and staff should know to ensure the physical and emotional safety of your child? (for example cultural practices, disability, anxiety, behavioural problems, phobias about height/small places etc).
  • Parent/Caregiver Information:

  • Please enter a valid email address to receive a emailed version of this form once completed.
  • Parent/Caregiver Consent

    Please tick the boxes below to complete the Parent/Caregiver Consent.
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Contact details

Book a School Tour

Come and see all that Southland Girls’ High School offers students with a school tour that allows you to see our facilities in action, while meeting the staff and the students.

Student tour guides will answer questions and offer a student’s perspective, before meeting with a senior member of staff to discuss your child’s enrolment.

To book in for a tour of the school, please email Deb Hay, [email protected] or telephone 03 211 6030.

Book a Tour of Enwood House

Come and see all that Southland Girls’ High School offers boarders with a tour of Enwood House that allows you to see our facilities in action, while meeting the staff and the students.

To book in for a tour of the boarding house, please email Jenni Dennis, [email protected] or telephone 03 211 6030.

RISKS Disclosure

This event contains risks, including sporting injuries. This event is managed by school staff or the sport organisations who will manage risk and hazards according to the school’s/sports organisations safety management plan. 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 our Sports Office 03 211 6030 or email [email protected]


I understand that playing sport is an opportunity for me to learn, practice skills, and gain attitudes and values in an environment outside of the school.  I realise that this requires me to take on genuine responsibility for my own enjoyment and safety and that of others.

I agree to do the following to make this happen:

  • Show courtesy and consideration to others.
  • Follow the rules and instructions of staff and other supervisors at the events.
  • Look after myself and my personal belongings.
  • Declare medical conditions that could affect participation in the events.
  • Accept the rules set by the school for the events.

I understand that my parents / caregivers will be contacted and I may be sent home at their expense if:

  • My actions are considered unacceptable by staff / supervisors of these events.
  • I breach the behaviour / discipline standards of the school.
  • My actions put me or others in any danger.
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