(please keep for your information)

On WEDNESDAY 19th October our Middles Team Rooms 4,5 and 6 are spending the day and night participating
in our Education Outside the Classroom Experience. In order for you child to attend, we will require the attached
permission, health and medical records and payment to be completed.
Permission, Health and Medical Forms and Parent Help forms need to be completed and handed in no later than
Tuesday 11 October giving you the two week holiday break to organise and complete.
Payment will need to be finalised by Friday 14th October please.

If you have sold a full box of chocolates, you have paid $24 of the $26 required for this event. I will attach an
invoice to the front of this notice with what is owed as of 22nd September 2016. If you sell further chocolates
after this date, please bring your invoice and outstanding chocolate money to Sheryl in the office. If you do not
have an invoice attached you will be required to pay the full amount. Thanks.
A brief outline of our day and night time programme follows: (Times approximate)
WEDNESDAY 8.45am:
Bell rings and children meet in their home classrooms for roll. Dropping their overnight gear in the hall please
(Rm4 left hand side of hall, Rm5 in front of stage, Rm6 Right hand side of hall).
9.15am:
All children and adult helpers to meet in hall so we can group into teams, assign parent help teams and ensure all
daytime gear/equipment is properly organised.
9.45am:
Depart on Bus to Silky Oak Chocolate Factory (parents will need to car pool for transport as this has kept our
costs down see parent helper form).
10am:
Arrive and split into groups A and B
10.15am
Group A = Tour
Group B = Morning tea, activity sheet and shop tour
10:50am:
Group B = Tour
Group A = morning tea, activity sheet and shop tour
11:30am:
Load bus and travel to Marine Parade Playground. We will organise a lunch eating area and once dismissed by
teacher from eating, children will have a play.
12.30pm:
Load bus and travel to Ocean Spa. Children will be changed in groups and monitored by teachers, adult helpers
and life guard staff. Before entering the pool we will have a safety and boundary de-brief.
3.15-3.30pm:
Load bus and leave for Bay City Outreach Centre Omahu Rd.
4pm:
Arrive and sit down for safety and boundary debrief.

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4:15pm:
Split into groups where teachers will supervise and run activities in different areas of the facility. Parent
helpers at this point will start meal prep (menu/instructions provided).
5.15/30pm:
Clean up for dinner.
5:30pm:
Dinner and Dessert
Pack up and clean a team of kids will be assigned to help with this.
6.45ishpm:
Settle, debrief and Discoooooo

7.45pm:
Settle, supper,
debrief, clean up, set up bedding.
8:30pm
PJs, teeth, toilet, bed for a movie
Children will settle with movie. A light will remain on in hallway but not so that it keeps people awake. Toilets are
easily accessible and adult helpers will position themselves around the horse shoe sleeping arrangement.
We will have a staff member and one other adult sleeping in a separate lounge area for any children that may
need a less crowded space.
MORNING:
7.30 - 8:00am:
Wake/rise children from beds to get dressed and washed up. Clean up bedding area. Breakfast prep with adult
helpers.
8:00am (ish)
Breakfast and clean up
9;15am (ish)
Lunches: Will have a food chain process of making their own cut lunch with help of adults and then settle in
auditorium for quiet time/planning
9:45am:
Talent quest (volunteer basis casual) while adult helpers and teams of children pack bus and trailer.
10: 30am: (ish) (no later than 11am)
Load bus and return to school for school based activities in classrooms follow up. (If you wish to meet us at
school around 11am to take your child home early that is fine, we just need you to collect an early pick up slip
from the office first.
Childrens gear will be placed back in the hall and organised into their wall spaces, the hall will be locked until the
end of the day. Please see myself in Rm5 or the office if you wish to collect this earlier and we will unlock the
space for you !

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please return to school

It is important that this PARENTAL CONSENT and RISK DISCLOSURE form and the HEALTH PROFILE are
completed for all student participants of the camp.
The purpose of the forms is to enable the school to ensure that optimal staffing levels are provided, specific to
the needs of participants are met and the safety of events is maximised.
Details of these forms will remain confidential to school staff, contractors and volunteers associated with
supervising activities on the EOTC event.
For safety 4reasons, please provide us with information that is accurate and complete.
PLEASE RETURN THESE FORMS TO THE CLASS TEACHER BY TUESDAY 11 OCTOBER 2016.

Please complete the details:

Childs name: _____________________________________________________________
Address: ________________________________________________________________
Current phone contact: ______________________________________________________
Who is this contact? ________________________________________________________
Relationship to child: ________________________________________________________
Family Doctors Name: _______________________________________________________
Medic Alert Number (if applicable):_____________________________________________

EMERGENECY CONTACT DETAILS (please provide names of 3 people)

NAME

RELATIONSHIP

DAY PHONE (CELL)

NIGHT PHONE
(HOME)

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PARENTAL CONSENT

please return to school

I agree to my child taking part in the EOTC event and have read the information sheet. I
agree to their participation in the activities described. I acknowledge the need for them to
behave responsibly. . Children who display behaviour that endangers

themselves or others in any way will be withdrawn from activities and

activity costs will be non-refundable.

PARENTAL CONSENT
I have read the EOTC event information sheet and I understand that there are risks associated
with involvement in school EOTC events and that these risks cannot be completely eliminated. I
understand that the school will identify any foreseeable risks or hazards and implements correct
management procedures to eliminate, isolate or minimise those hazards. I understand that my child
will be involved in the development of safety procedures and will be fully aware of these.
I know that I am able to ask questions of the school about the activities my child will be involved in
to gain a better understanding of the risks involved. I recognise that participation in such activities
is encouraged but not mandatory. My child may withdraw from the activity if they feel at risk. This
myst be done in consultation with the person in charge.
I understand that the school does not accept responsibility for loss or damage to personal property
and that it is my responsibility.
I accept responsibility for the collection of my child if their behaviour endangers themselves
or others in any way.

Tick the option that is applicable for your child.

My child will be
attend both
daytime activities
and the overnight
stay

My child will attend daytime

activities, dinner and disco only.
I will collect them before 8pm
from Bay City Outreach Centre
Omahu Rd, returning to Bay City
Outreach Centre no later than
8.30am on 20th October.

My child will not be

attending this EOTC
event. I understand that
they will be my
responsibility on this day
or if attending school as
normal will be allocated to
either another classroom.

Print Name: ______________________________________________

Signed: _________________________________________________
Date: ___________________________________________________
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Mayfair Middles EOTC 2016

ADULT helpers form please return to school
In order for us to successfully, safely and legally participate in this EOTC event as a team we require the
assistance of parent/adult helpers who are over 18 years of age, without the responsibility of pre-school or other
children in their care on the day/night they attend.
Please consider this as we require high ratios of adult:children, particularly around water activities.
Our overnight stay (sleeping overnight) requires all accompanying adults to have been police vetted. We sent out
a form at the beginning of the year for those who were interested in participating in overnight events as the
police vetting process takes a long time to return and therefore only those on our records or who can provide
evidence with our office staff will be considered for the OVERNIGHT STAY part of the event. Those parents
who are on our records, as being police vetted will have this indicated on their particular form.
Please complete and return no later than Tuesday 11 October 2016, Thank You.

Please tick all relevant boxes

I AM able to assist with the daytime EOTC activities

9.30am 4.30pm WEDNESDAY 19th October

I AM able to assist with evening activity supervision and meal/supper preparation 3pm 8pm at Bay
City Outreach Centre
I AM able to assist with MORNING lunch service and morning activities/clean up. 8.30am 11am

OVERNIGHT ASSISTANCE.
OFFICE USE ONLY:
_____________________________ has been police vetted and is on record at Mayfair School as being able
to stay overnight at this EOTC experience

_____________________________ has been police vetted via another organisation and is able to provide
appropriate evidence with our office staff.
Signed Office Staff Only : _____________________________ Date:______________________
Name of Office personale:_________________________________

_____________________________ (stated above)

is ABLE to assist and stay OVERNIGHT 8pm WEDNESDAY 19th October 7.30am 20th October

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Mayfair Middles EOTC 2016

ADULT helpers form please return to school

Name of Adult helper: _____________________________________

Child: ___________________________Room: __________________

Relationship to child:______________________________________

Daytime Phone (cell): _________________________________________

Nightime phone: ____________________________________________

I have a registered/warranted vehicle and full licence that I am willing to use

to car pool myself and other adults for daytime activities:

YES/NO

I require transport for daytime activities

YES/NO

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Mayfair Middles EOTC 2016

HEALTH AND MEDICAL form please return to school

Childs name: ____________________________________________ Room: _______________

Please tick if your child has any of the following:

Migraine

Epilepsy

Asthma

Diabetes

Travel Sickness

Seizures of any type

Nose bleeds

Heart condition

Dizzy spells

Colour blindness

ADHD

Sleep walking
Other:

Bedwetting

Anxiety attacks

Further Details/comments:

Is your child currently taking medication?

YES

NO

IF YES please state:

Ailment: ____________________________________________________________________

Name of medication: ___________________________________________________________

Dosage and times to be taken: ____________________________________________________

Other treatment: _____________________________________________________________

Has your child had any major injuries (breaks or strains) or illness (glandular fever etc..) in the last 6 months
that may limit full participation in any activities?
YES

NO

If YES please state the injury/illness: _______________________________________________

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Mayfair Middles EOTC 2016

HEALTH AND MEDICAL form please return to school pg2
Please indicate any allergies that your child may have:
YES

NO

NOT SURE

SPECIFY

Prescription medicine
Foods
Chocolate
Bites and stings
Other allergies
What treatment is required for reactions?

When was your childs last tetanus injection?

Pleas outline any dietary requirements. (not what they dont like and do like but specific
allergies or diets) ___________________________________________________
_________________________________________________________________
_________________________________________________________________

What pain medication may be given to your child if necessary? (ie panadol etc)
_________________________________________________________________
_________________________________________________________________

To the best of your knowledge, has your child been in contact with any contagious or
infectious diseases in the last 4 weeks.
YES
NO
If YES, please give brief details: _______________________________________
_________________________________________________________________
_________________________________________________________________

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Mayfair Middles EOTC 2016

HEALTH AND MEDICAL form please return to school pg3

Is there any information the staff should know to ensure the physical and emotional
safety of your child?
YES

NO

If YES please state or attach information

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
I also agree that if prescribed medications needs to be administered, a designated
adult will be assigned to do this. I will ensure that prescribed medication is clearly
labelled, securely fastened and handed to the designated adult with instructions on its
administration.
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 EOTC event.
I agree to the person in charge seeking medical attention for my child if necessary.
Any medical costs not covered by ACC or a Community Services card will be paid by me.
If my child is involved in a serious disciplinary problem or actions that threaten the
safety of others, s/he will be sent home at my expense.
Print Name (parent/caregiver): _____________________________________

Signed: _____________________________________________

Date: ______________________________

Childs Name: _____________________________________________

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