In-term Swimming Lessons – MULLALOO BEACH

Interm Swimming Parental Consent

Please return to the office by Monday 16^th February 2026.

I have read and understood the attached information regarding the Interm Swimming Excursion from Monday 23^thFebruary 2026 to Friday 6^th March 2026 and I understand the nature of the activities proposed and the supervision arrangements.
I accept and understand that:
the school and its employees are not responsible for personal injuries
any costs incurred as a result of accident or illness are my responsibility; and
the school and its employees are not responsible for any loss or damage to my child’s personal property that may occur during the excursion.

I agree to inform the organisers well before the scheduled excursion departure of any change to my child’s health and fitness so that appropriate supervision may be arranged.

I understand and give consent for school staff to arrange to present my child for medical assessment and treatment if deemed necessary and I give permission for my child to receive medical treatment in case of an emergency.

Please provide all details

Student details

Student Name*

First Last

Date of Birth*

Parent/guardian Name*

First Last

Address*

Street Address Address Line 2 Suburb Postcode

Parent/Guardian Phone Number (Mobile)*

Parent/Guardian Phone Number (Work)

Name of family doctor*

Phone Number*

I give my consent for my son/daughter

from Room

to participate in the Interm Swimming at Mullaloo Beach for 9 days from Monday 23th February to Friday 6th March.

EFTPOS or Credit Card at the front office $85.00

Direct Debit $85.00
Padbury Primary School
BSB: 066 160
Acct: 009 000 80

PAYMENT RECEIPT

# ChildSurname/Room Number/SWIM

Signature of parent/guardian Date:

Medical details

Is your child subject to seizures, fainting, epilepsy, diabetes or any other condition that may affect his or her safety during the excursion?*

Yes

Please provide details*

Is your child allergic to:*

Penicillin

Any other drug

Any food

Other

none of the above

Please provide details*

Date of last tetanus vaccination:*

Medication
Parents/guardians are requested to make arrangements with the teacher-in-charge for the safekeeping and handling of medications prior to the excursion.

Is your child presently taking tablets and/or other forms of medication?*

Yes

Medication Name:

Does your child self-administer the medication?*

Yes

Medication Dosage & Frequency:

Other Information: Please provide any other information which the organisers should be aware of:

INTERM SWIMMING ENROLMENT FORM

TO BE COMPLETED BY PARENT:

I give my child Age School

Room Number permission to attend Department of Education’s Interm Swimming classes at

Commencing on Enclosed is payment of (Lessons for Government schools are free. Payment is for transport and pool entry)

Is your child subject to asthma, seizures, fainting, epilepsy, diabetes, allergies or any other condition or disability* that may affect his/her safety, or require the school to provide learning adjustment?

YES

Please provide further information below if necessary**

Please provide details of medication currently being taken (if applicable):

Is there any other information swimming staff should be aware of to enable your child to fully participate in Interm Swimming lessons? (e.g previous incidents in water related activities) IF IN ANY DOUBT PLEASE CONSULT YOUR SCHOOL PRINCIPAL.

*Swimming staff cannot take responsibility for medical conditions or diagnosed disabilities that are not listed on the returned form.

**If necessary please consult your Principal well in advance of swimming lessons to discuss appropriate learning adjustments.

I agree to inform the organisers before the scheduled departure of any change to my child’s health and fitness. Where it is not practical to communicate with me, I authorise the school staff to consent to my child receiving such medical treatment as considered necessary

My child is going for Stage Number *

Please enter number from the list

Unsure please grade

Please enter number from the list

My child has attempted this ‘going for’ stage three times in Department of Education classes without passing Please attach copies of last three (3) Department of Education certificates.

Please enter number from the list

Signature:* Parent daytime phone number:* Date:*