I/We give my permission for my child (indicated below) to participate in all sports and school-sponsored trips away from the school premises throughout the current school year. Students will be accompanied by a teacher and will always be under adequate supervision. I/We understand that I/we will be given at least 48 hours notice of all trips away from the school premises. I/We further understand that I/we may revoke permission for a specific field trip by written notice hand-delivered to the school office more than one day prior to the trip.

Although the school desires to provide a safe and enjoyable time for all students, accidents can still happen. I/We understand that there are risks/dangers involved with participation in off-campus trips and their associated activities. In consideration of my child being allowed to participate in this event, I/we assume to accept responsibility for those ordinary and reasonable risks associated with travel and activities. I/We agree to hold harmless Ebenezer Christian College, its employees, agents, and representatives, including volunteer and other drivers, from any and all claims arising from my/our child’s participation. This release agreement does not apply to claims of intentional misconduct or gross negligence by the school, its employees, or volunteers. In case of accident, illness, or other emergency, I/we request that the school contact me. If the school cannot reach a parent/guardian after conscientious effort, I/we give permission for school staff to call paramedics or any licensed physician or dentist. If a life-threatening emergency exists, I/we give permission for school staff to call paramedics immediately and then contact me/us as soon as possible thereafter.

I/We authorise and consent to any x-ray examination, anaesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care, which, in the judgment of a licensed physician or dentist, is deemed advisable. I/We agree to assume the financial responsibility for expenses incurred as a result of those services being provided. I/We also agree to be financially responsible for emergency medical transportation.

School Year

The School Year in which the student is enrolled (if it is the student's FIRST enrolled year) or the current school year if the student has already been enrolled.

Student Name

First Name

Last Name

Year Level

Student Home Number

Agreement

I have read and agree to the above statements of Ebenezer Christian College's Annual Field Trip Release.

Parent/Guardian Information

Parent/Guardian 1

First Name

Last Name

Parent/Guardian 1 Mobile Number

Parent/Guardian 1 Work Number

Parent/Guardian 2

First Name

Last Name

Parent/Guardian 2 Mobile Number

Parent/Guardian 2 Work Number

Nominated Family Email Address

Health Care Information

Medicare Number

Please add the child's Idenitfication Reference Number in brackets next to the Medicare Number.

Preferred Hospital

Physician

First Name

Last Name

Physician Contact Number

Dentist

First Name

Last Name

Dentist Contact Number

Health Insurance Carrier

Health Insurance Policy Number

Health Insurance Holder

First Name

Last Name

Insurance Holder's Relationship to Student

Allergies and/or Medical Conditions

Allergies including reactions to medication.

Medication Being Taken

Emergancy Contact

In case of emergency, please provide the details of nearest relative or neighbour we should contact if we are unable to contact you at home or work.

Emergency Contact

This contact SHOULD NOT BE EITHER PARENT/GUARDIAN 1 OR PARENT/GUARDIAN 2 as this person will be contacted if either parent/guardian is unreachable.

First Name

Last Name

Relationship to Student

Emergency Contact Number

Annual Field Trip Release/Emergency Medical Form