CAMP/EXCURSION INFORMATION FORM

VINNIE’S WINTER SLEEP OUT – 17TH JUNE 2016 16th May 2016 Dear Parents and Caregivers, This term, the Senor School Council will be hosting a Vinnie’s Winter Sleep out. Every night, more than 105,000 Australians sleep rough and a quarter of these are under 18 years of age. Homelessness is a problem often overlooked and misunderstood in Australia. We are inviting all Year 10, 11 and 12 students to rise to the challenge and swap their beds for a piece of cardboard for the night and experience what it’s like to be homeless, in aid of the St Vincent de Paul Society. This hands-on event will encourage students to understand the problem they are helping to solve and provide an opportunity to take action.

VINNIE’S WINTER SLEEP OUT

Teacher responsible Ms Jessica Rossi

Location Cabra Dominican College – St Dominic’s Square

Dates of Activity Friday 17th June 2016

Time 6.00pm to 8.00am the following day

Sponsorship Students are encouraged to raise money through sponsorship to participate in the event, using the sponsorship form attached.

Details Students will be experiencing what it is like to spend a night without warmth or comfort and as such, will be using cardboard boxes and a sleeping bag on the night. A simple meal will be provided for dinner and we ask that students do not bring snacks with them.

Students will be sleeping in St Dominic’s Square, which is secure, has access to bathrooms as well as an alternative sheltered sleeping area. As a community we will also be conducting a can and blanket drive in the weeks prior to the sleep-out and will be donating our efforts to St Vincent de Paul. Collection bags will be available to students in their home class.

For further information, please contact us at the College on 8179 2400. There are limited spaces available so please return forms asap to the Student Services Office by Tuesday 14th June 2016. Thank you for your support of the Cabra Dominican College Vinnies Winter Sleep out. We hope that your son/ daughter will embrace and enjoy this unique experience. Yours sincerely

Ms Jessica Rossi Senior Leader Co-ordinator

EXCURSION AND CAMP CONSENT FORM 2016

VINNIE’S WINTER SLEEP OUT - 17th JUNE 2016

STUDENT’S NAME: HOMEROOM:

PARENT/CAREGIVER NAME:

I / we give consent for the above student to participate in:

NAME OF ACTIVITY

LOCATION

DIETARY REQUIREMENTS

I / we have provided the school with a Health Care Plan / Action Plan for 2016 Yes No N/A (If you have marked ‘No’ please ensure that you submit a current Health Care / Action Plan where applicable)

I / we have completed a Camp / Excursion Medical Information form Yes No

Details of planned activities, transport arrangements, supervising teachers/instructors are attached

Agreement

• I agree to delegate my authority to supervising teachers/instructors. Such supervisors may take whatever disciplinary action they deem necessary to ensure the safety, well-being and successful conduct of the students as a group and individually.

• In the event of any serious misbehaviour on the part of my child, I understand that I will be contacted and will be responsible for any costs associated with my child’s return.

• In the event of an accident or illness, and in an emergency situation where an ambulance is not available within a reasonable period of time, I consent to my child being transported to a hospital/ medical/ dental clinic or to an ambulance by an excursion staff member in a school/ private car as so advised by emergency services.

• In the event of an accident or illness and contact with me being impracticable or impossible, I authorise the teacher-in-charge to arrange whatever medical or surgical treatment a registered medical practitioner considers necessary. I will pay all medical and dental expenses incurred on behalf of my child.

• I have provided all information necessary for the school to plan safe and reasonable health care support for my child. This includes, if relevant, information about any activity modifications my child may require for medical reasons.

• I have also attached additional or updated health care information, including details of any additional health support he/she requires to undertake the above activities safely.

• I consent to my child’s doctor or medical specialist being contacted in an emergency. • The information given is accurate to the best of my knowledge.

Parent / Caregiver (1) Print name

Signature Date:

Parent / Caregiver (2) Print name

Signature Date:

Confidential Medical Information for Overseas, Interstate and Overnight Camps,

Sleepovers and Excursions (This is a legal requirement) This information is intended to assist the school in case of any medical emergency involving your child. A copy of this information will be held by the school contact person and the originals will be held by the teacher in charge of the excursion. All information is held in confidence. Student’s First Name Student’s Surname

Date of Birth Home room

Address Post Code

Parent/ Carer (1) Contact number

Parent/ Carer (2) Contact number

Emergency contact name and number (other than the numbers above) Relationship to child

Name of Family Doctor Contact number

Medicare Number Position number Expiry date

Private Health Fund

Number: Table:

Health Care Card number

Previous experience – is this the first time your child has been away from home? Yes No

Please tick if your child suffers any of the following:

Bed wetting Fits of any type Heart condition Asthma Diabetes

Dizzy spells Sleepwalking Blackouts Migraine Travel sickness

Anxiety disorder SARS Other (please specify)

Allergies Penicillin Other medication Any food Other (please specify)

What special care is recommended?

Is there a Health Care Plan in place?

Does the school have an up to date copy of the Health Care Plan? Yes No

Does your child require any modifications to this Health Care Plan? Yes No

Please specify

Year of last tetanus immunisation (tetanus immunisation is normally given at five years of age (as Triple Antigen or CDT) and at 15 years of age (as ADT)

Year

EMERGENCY TREATMENT

Please provide details of emergency and how to recognise it? Provide extra attachments if needed.

MEDICATION

Does your child need to take medication while on camp/retreat/ interstate/overseas? If ticked yes, please complete below.

Yes No

If yes, please provide medication and a Medication Authority Form in a zip lock bag to the college.

• A Medication Authority Form is required for all medications administered at school or on a school camp/sleepover etc. • Even if you have a current Medication Authority Form submitted with the school, you will need to fill out a new form if the medication dose

times have changed i.e. taken outside of school hours e.g. in the morning/night. NOTE: The college is not allowed to administer Panadol or a similar product under any circumstances unless we have a

Medication Authority Form. If YES, please state name of medication, dosage and when to take medication.

Medication name Dosage Time/s to be taken

All medication must be in original packaging labelled with your child’s name, the dose to be taken, specific storage conditions, and when it should be taken. If it is necessary for your child to carry his or her own medication (for example, asthma puffers or insulin for diabetes) it must be with the knowledge and approval of both the teacher-in-charge and yourself.

SELF-MEDICATION

Will your child be self -administering their medication (including any over –the-counter medication)?

Yes No

If yes, I / we, the undersigned, will supply all medication with a Medication Authority Form in a zip lock bag, in original packaging labelled with my child’s name, the dose to be taken and when it should be taken. I acknowledge that my child is responsible for carrying the medication and taking it as prescribed by the doctor on the Medical Authority Form. My child, if they are in the Middle school, will notify the teacher- in-charge on every occasion when he/she takes medication. The teacher-in-charge has been notified of this individual arrangement.

CONSENT TO MEDICAL ATTENTION

In the event of an accident or illness involving my child, and contact with me or the emergency contact being impossible or unsuccessful despite continued attempts, I authorise:

• The teacher-in-charge as my nominee to give consent to the appropriate medical or dental authorities for my child where such authorisation is required eg. General anaesthetic, blood transfusions etc. I give this consent on the understanding that the teacher-in-charge will, if at all possible, contact me by telephone prior to consenting to the administration for the medical or dental treatment by the medical practitioner, dentist or hospital concerned. However, if the medical or dental practitioner considers that the medical or dental treatment should be administered immediately, and the teacher-in-charge is unable to contact me, I authorise:

• The teacher-in-charge to consent to the administration of medical or dental treatment.

• The supervising staff to administer such first aid as the teacher-in-charge may judge to be reasonably necessary.

• In the event of an accident or illness, and in an emergency situation where an ambulance is not available within a reasonable period of time, I consent to my child being transported to a hospital/ medical/ dental clinic or to an ambulance by an excursion staff member in a school / private car as so advised by emergency services. Continued attempts to inform the parent or emergency contact will be undertaken in such circumstances until contact is made. I understand that in the event of illness or accident to my child, I will be responsible for all associated costs and charges, including ambulance transportation. It is a requirement of the school that students involved in overseas travel take out travel insurance. Please ensure that any documents relating to travel insurance are kept in a safe place. Parent / Caregiver 1 Print name Signature Date

Parent / Caregiver 2 Print name Signature Date

St Vincent de Paul Winter Appeal Sponsorship Form

Every night, more than 105,000 Australians sleep rough and a quarter of these are under 18 years of age. Homelessness is a problem often overlooked and misunderstood in Australia. We are inviting all Year 10, 11 and

12 students to rise to the challenge and swap their beds for a piece of cardboard for the night and experience what it’s like to be homeless, in aid of the St Vincent de Paul Society. This hands-on event will encourage students to understand the problem they are helping to solve and provide an opportunity to take action.

Please return your forms and your money to the Student Services Office. Total Amount Raised: $

Name Amount Paid