Peregian Springs State School eNewsletter

Medical Consent Form - Complete only if student medical details have changed

The Department of Education and Training, through Peregian Springs State School, is collecting personal information in accordance with Education (General Provisions) Act 2006 in order to maintain student medical consent records. The information will only be accessed by Department of Education and Training. The information will not be given to any other person or agency unless consent is provided.

Only complete this form if your child’s medical details have changed.

Child's Last Name *

Child's First Name *

Class *

Date of Birth *

Medical Treatment

In the event of an accident or illness, I authorise school staff to obtain or administer any medical assistance or treatment my child may reasonably require, including contacting my child’s doctor. *

Yes

Medical or Physical Needs

I have provided the school all relevant details relating to my child’s medical or physical needs on enrolment and where relevant have updated this information. *

Yes

Medical Costs

I accept liability for all costs incurred in obtaining such medical assistance or treatment (including any transportation costs) and undertake to reimburse the State of Queensland (via the Department of Education and Training) the full amount of any costs incurred on my child’s behalf. *

Yes

Additional Medical Information

The school collected medical information about your child at enrolment. This information is stored in OneSchool. Please give full details of any new or changing conditions (medical, physical or management) which may affect your child’s full participation in school activities. An emergency action plan may be required – refer school office.

Current Prescribed Medication(s) if applicable

Please complete additional consent forms in the school office for the administration of medication if required during school hours.

Child's Medical Practitioner (optional)

Medical Practitioner's Telephone Number (optional)

Medicare No. (optional)

Private Health Insurance Company (optional)

Membership Number - Private Health Company (optional)

OneSchool records

If an enrolment form for your child has been completed or updated since October 2012 the information which you provided will already be recorded in OneSchool. I would like this additional information about my child’s medical and physical details to be recorded in OneSchool records. *

Yes

Activity Risks Insurance

There is an inherent risk with school activities of physical injury occurring. Please note that the Department of Education and Training does not have personal accident insurance cover for students. If your child is injured as a result of an accident or incident, all costs associated with the injury, including medical costs are the responsibility of the parent/carer. Some incidental medical costs may be covered by Medicare. If you have private health insurance, some costs may be also be covered by your provider. Any other costs must be covered by parents/carers. It is up to all parents/carers to decide what types and what level of private insurance they wish to arrange to cover their child. Please take this into consideration in deciding whether or not to allow your child to participate in a particular activity. I understand and acknowledge the above. *

Yes

Medical Details Confirmed

I have checked on QParents or with the school office that my child’s other current medical details are correct *

Yes

Agreement

I understand by submitting this form I agree to all terms and conditions. *

Yes

Parent/Carer Name *

Email *

Signature *

Undo

Clear

Write your signature above the line

Date *