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Tour Medical Consent Form

If you have not already done so, before you complete the Medical and Tour Consent Forms, please complete the Expression of Interest form. 

Once you have completed the Medical Form below, you will be redirected to the Tour Consent Form. Both forms must be completed, along with your Expression of Interest and deposit payment. 

A note about medical information: 

PLC Sydney has a legal duty of care to all its students. In addition, the College wants to provide optimal care for students on tour. We cannot provide this care without full disclosure of information about your daughter’s health and psychological well-being. In order for us to fulfil our risk management
responsibilities, we need to take into account any and all medical and/or psychological conditions students may have.

Full disclosure of this information about your daughter does not preclude her involvement in any tour but enables staff to be aware of any issues which may arise while on tour and therefore deal with them effectively.

All information will be treated in strictest confidence.

Please complete the following question carefully and openly. You may wish to follow up with an interview with the organising teacher or with the Director of International Studies.

Student Detail
Medical Information

Within the fields below please list the following information.

  1. List existing medical conditions, illnesses (including asthma, diabetes, epilepsy, allergies, psychological conditions, etc) or disabilities. Outline the treatment for each.
  2. Outline special dietary needs including possible reaction to inappropriate diet.
  3. List medications to be administered during the excursion. Include name of medication, name of condition being treated, time of administration, and any possible reactions.
  4. If your daughter is under a specialist’s treatment for any condition that may affect her adversely while she is on tour please attach a release letter from her specialist approving her participation in the tour.
  5. Additional information:  Is there any information which will be helpful to staff in managing your daughter and in providing a safe and beneficial education experience? Conditions you should mention include depression, panic attacks, fear of crowds, agoraphobia, claustrophobia, food allergies or anaphylaxis, ADHD, but there may be others.
Medications

In the section below you are required to list any other medications (eg Ritalin, Ventolin, Epipen injection for anaphylaxis, glucagon injection for diabetes) that your daughter may need and the name of the condition being treated. I

f your daughter requires these medications please supply the medication in its original packaging to the senior staff member going on tour, with your daughter’s name and with written instructions as to dosage and specific times for administration.

For more serious conditions such anaphylaxis requiring Epipen use or diabetes requiring glucagon injections, or panic attacks, we require a medical certificate from your doctor describing the condition and how it is to be managed on a tour situation.

If you wish to vary any of these arrangements you must discuss this with the Head of Senior School first and you and your daughter must give written consent to the different arrangements.

Please place a tick in the the boxes below for each medication which you authorise staff to administer to your daughter if required.

Authorised Medications
Consent and Authorisation

Please note that by submitting this form,  I/we authorise staff members to administer general first aid treatment for minor injuries or illnesses experienced by my daughter except any exceptions listed below (please note any exceptions to the administration of first aid treatment below).

My submitting this form:

  • I/we give consent to the responsible adults of the tour seeking medical or dental advice on behalf of my daughter as they see fit in the event of accident or illness. If, in the opinion of the attending medical or dental practitioner or medical officer, my child requires medical or dental attention or treatment including but not limited to the administration of anaesthetic, blood transfusion or the performance of any surgical operation, I/we consent to such medical or dental practitioner or medical officer giving such treatment.
  • I/we acknowledge that the responsible adult will take all reasonable care of my daughter; however, neither they nor the school will be responsible for the cost of any medical or dental attention or treatment administered to my daughter.
  • The accompanying staff member will not be responsible for any act or omission of any medical or dental practitioner or medical officer attending or treating my daughter.
  • I also consent to the administration of the medications specified in this form and any others notified by me in writing.
Relationship to Student:* - required
Mandatory field(s) marked with *