The Gifted and Talented Childrens Association

S O U T H A U S T R A L I A

Medical Consent

Dear Parents/Caregivers, To enable us to care for your child while at Glenunga International H.S. for Saturday Club, or at an Away Session, the following information is required: Childs Details Parent/Guardian Details Telephone numbers where the parent or caregiver can be reached. Name: Home: Work: Mobile: Other:

Childs Name: D.O.B: Address: Suburb: Postcode:

Alternate Contacts

Person/s to contact if Parent/Caregiver cannot be contacted Name: Relationship to Child: Name: Relationship to Child: Name: Relationship to Child: Doctor Phone: Mobile: Phone: Mobile: Phone: Mobile: Dentist Name: Address: Phone:

Family Doctor or Medical Centre Name: Address: Phone:

Office Use Only Date Received: Page 1

ABN 214 538 398 52

The Gifted and Talented Childrens Association

S O U T H A U S T R A L I A

Medical Information Parents, please list your childs past & present major illness, and medication required (eg: Asthma, convulsive seizures, etc.) Condition Medication

Allergies:

If you fail, or neglect to provide sufficient and current information, in writing, to enable the proper treatment of your child, no liability will be accepted by The Gifted and Talented Childrens Association of South Australia, for any injury or illness which your child may suffer as a result Medical Consent Should it be necessary for our child to receive medical attention whilst at a Saturday Club session or excursion, I hereby give the Gifted and Talented Childrens Asscociation (GTCASA) permission to use its judgement in obtaining the necessary service, as required. We understand that any cost incurred, will be our responsibility. Parent/Guardian Signature: Date:

This form must be completed by a Parent /Guardian and sent to GTCASA before the first session at Saturday Club. Parents/Caregivers must remain within the grounds of Glenunga International H.S. if your child is attending a Saturday Club Session. Please use the Parents/Caregivers retreat.

Page 2

ABN 214 538 398 52