Kinder Excursion Consent and Payment FormPlease enable JavaScript in your browser to complete this form.Fields marked with an * are required. As a Parent/Guardian of *FirstLastEnter Child's First Name and Last Namein ClassLittle KinderBig KinderPrepI *FirstLastEnter Parent/Guardian First Name and Last NameEmail *Multiple Choice *give my consentdo not give my consentfor him/her to participate in our excursion toonI agree to delegate my authority to the Staff and Instructors involved. The school contact person will beClass Teacher Email ID *rebecca.rassavong@drss.vic.edu.aukarin.penny@drss.vic.edu.auellise.peart@drss.vic.edu.auI authorise Teachers and Instructors to take appropriate action necessary to ensure the safety, well-being and successful conduct of the students as a group, or individually at this excursion and related activities. If any student is unable or refuses to comply with requests, the Teacher may ask parents to come and take the student home. I also authorise the Teachers and Instructors to obtain medical assistance which they deem necessary should an accident occur, and agree to pay all medical expenses incurred on behalf of the above student. I submit the attached medical information about the above student and include details of limitations which he/she has for the activity concerned. I further authorise qualified practitioners to administer anaesthetic if such an eventuality arises.Emergency Contact for Excursion Day *FirstLastEnter First Name and Last NameContact NumberMEDICAL INFORMATIONHeart ProblemYesNoDetails, if any *Respiratory ProblemYesNoDetails, if any *Allergies YesNoDetails, if any *Travel SicknessYesNoDetails, if any *Blood PressureYesNoDetails, if any *PhobiasYesNoDetails, if any *OperationsYesNoDetails, if any *Recent IllnessYesNoDetails, if any *Drug Reaction (e.g. Penicillin Allergy)YesNoDetails, if any *Other InformationYesNoDetails, if any *Are you a driver for the excursionYesNoTRANSPORT INFORMATION (if you are a driver for the excursion please ensure the Office has the following details)Driver Name *FirstLastEnter First Name and Last NameLicence No. *Comprehensive Insurance *YesNoPolicy Number *Car Registration *Insurer *Policy Expiry Date * Amount to PayPayment *CardName on CardChoose OneParentGuardianSignature * Clear Signature Date *PhoneSubmit