Parent/Carer Authorisation Club/Activity

Please complete this form regarding your child's school trip or workshop.

CLUB OR ACTIVITY* DATE OF EVENT* CHILD'S FULL NAME* SELECT YOUR CHILD'S YEAR GROUP/CLASS* PARENT/CARER NAME* PARENT/CARER CONTACT NUMBER* NAME OF PERSON PICKING YOUR CHILD UP* WILL YOUR CHILD BE WALKING HOME ALONE AFTER THIS EVENT? : (Year Six Only)* DOES YOUR CHILD REQUIRE MEDICATION ON AT THIS EVENT? IF SO - WHAT MEDICATION AND HOW OFTEN? :* DOES YOUR CHILD ATTEND KOOL KIDS ON THE DAY OF THIS EVENT?