Please note: Board financial procedure requires payment in full, by the due date for your child to purchase resources, participate in sports or attend trips/events. Payments received will be allocated to the oldest unpaid fees and charges owing on your child’s account first. Extra-curricular activities operate on a “pay before you play” policy.

This event contains risks associated with travel and sport, including road travel and common injuries like strains, sprains and dislocations. The tournaments are managed by outside organisations and SGHS staff and parent help will manage risk and hazards according to the school’s 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 contact our Director of Sport, Mrs Ashleigh Rabel at [email protected] or 03 2116030 Ext 256.

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 removal from activities and parents/caregivers contacted to collect their child.

"*" indicates required fields

Student Information:

The information on this form will remain confidential to the teachers/instructors in charge of/assisting with the 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

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)

Year Level

Year 9Year 10Year 11Year 12

Sport Events:*

Please tick which event you will be attending

Netball Tournament - 9A, 10A, 9/10A Christchurch 29 June - 3 July

Senior A Netball - Dunedin - 24-28 August

Junior A Basketball - Nelson - 22-27 August

Senior A Hockey - Nelson - 23-30 August

First XI Football - Timaru - 25-29 August

Transport Information:*

I give permission for child to be transported on this trip by the teacher in charge or bus company.

Yes (Agree to my child being transported)

Medical Conditions

Migraine

Diabetes

Chronic Nose Bleeds

Colour Blindness

Epilepsy

Travel Sickness

Heart Condition

Anaphylaxis

Bedwetting

Asthma

Seizures of any type

Dizzy Spells

Sleepwalking and or Sleeptalking

Home Sickness

Medication

If you child is taking any prescribed medication, dosage and times to be taken 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

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

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 attend the Tournament Sports trip.

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

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

The School reserves the right not to provide a refund if your child is unable to participate in this activity.

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

I acknowledge that should my child be selected for this tournament I agree to pay/fundraise the total cost of the tournament prior to departure 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 above.

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.

I agree and understand if my child is issued a sports uniform that is not returned or is returned in poor condition a fee will be added to my child's account to cover the cost of replacement

First Name

Last Name

Parent/Caregivers Email*

Parent/Caregivers Mobile*

Parent/Caregiver Signature*