Registration Form
Duke of Edinburghs Award Expedition for 2010
HUME AND HOVEL WALKING TRACK Expeditions FOR Silver and Gold STUDENTS
October School Holidays Sunday 3rd to Friday 8th October 2010
Sunday 5th to Friday 10th December 2010
First nights accommodation and meals, plus the expedition fee $128.00 per person.
Minimum number of people in a group 4 people maximum 8 people
Please print then mail or fax to the address below.
Parent consent
Duke of Edinburghs Hume and Hovel walking track expeditions for silver and gold students
Students name:
School Name: ..............................................................................
D of E Record Book number: .
Address:
.
.
I consent to my son/daughter attending the Hume and Hovell Duke of Edinburghs Award Expedition from _____________________ to_____________________
I am aware that the students will not be supervised at all times during the expedition as part of their requirements for their Duke of Edinburghs Award.
I have arranged the major forms of transport to and from their home address to Laurel Hill. I also consent to my son/daughter being transported at various times before, after and during the expedition in vehicles driven by staff from Laurel Hill Forest Lodge at Tumbarumba.
Signed: Date: .
Parents Signature
|
|
|
|
|
|
Medical Information Form
To be completed and sent with registration form.
Students name:
Medicare Number:
Parent or Caregiver contact details:
Name:
Address:
Home Phone: Work: Mobile:
Emergency contact details: nominated by the parent or caregiver as alternate contact
Name: Phone: Mobile
Name: Phone: Mobile
Family doctor contact details:
Name:
Address: Phone:
Health/ fitness aspects of the child that may require special attention, including existing medical conditions, illnesses or allergies.
Outline the treatment for each.
Are any medication(s) to be administered during the expeditions.
Include name of medication, instructions for administration, time of administration, and any possible reactions.
Outline special dietary needs including possible reaction to inappropriate diet.
Furthermore I authorize any officer, member or servant of the Duke of Edinburghs award, in the event of any accident or illness to obtain such urgent medical assistance or treatment for my son/daughter, including the administration of any anaesthetic or blood transfusion as he or she may consider expedient, and for this purpose to engage any first aiders, ambulance officers, doctors, dentists, nursing assistance or hospital accommodation and hospital fees (other than fees and expenses recoverable by the Duke of Edinburgh Award under any policy of insurance.)
Signed: Date:
Privacy Advice
The above information is being obtained in case medical assistance is required for your son or daughter over the course of the expedition.
Other persons and/or agencies that may be provided with this information are medical agencies such as ambulance officers, nurse and doctors to enable appropriate first aid treatment by providing an accurate medical history of the patient.
PAYMENT:
□ $128.00 per person
PAYMENT METHODS:
□ By cheque made out to Laurel Hill Forest Lodge Mail to 1670 Batlow Road Tumbarumba 2653
□ By direct deposit Westpac Bank Details: Laurel Hill Forest Lodge BSB 032 766 Account No.112395