Year 7 Camp Staff Consent and Medical Form ConsentYear 7 Alpine Discovery Program Consent and Medical Form* I have read and understood the activities to be included in the Year 7 Alpine Discovery Program. I have read and understood the risks associated with the Year 7 Alpine Discovery Program. Information required by the CollegeFull Name:* First Last Date of Birth:* Date Format: DD slash MM slash YYYY Home Address: Street Address Address Line 2 Suburb State Post Code Emergency Contact Name:* First Last Emergency Contact Number:*Emergency Contact Relationship to staff member:*Medicare Number:*Number on Medicare Card:*Medicare Card Expiry Date:*Private Health Insurance Provider:Private Health Insurance Number:Family GP Name:Family GP Contact Number:Medical Alert:Allergy Alert:Allergy Management Plan:Asthma Alert:Asthma Management Plan and triggers:Current Medications (names/doseage etc):Pre-existing injuries or recent injuries that may restrict participation in any activities on camp:Information for camp providerDietary Requirements:Skiing, Snowboarding or Neither?*Select:SkiingSnowboardingNeither - supervision duties for off snow studentsLevel of ability:*Select:First TimerBeginnerIntermediateAdvancedInterschools RacerNot skiing/snowboardingPurchase: Gloves ($25 charge) Neckwarmer ($10 charge) Goggles ($35 charge) Goggles ($65 charge) Socks ($15 charge) Hire: Jacket Pants Apre Boots (good for those not skiing) Height:Only required if hiring skiing/boarding equipment.Weight:Only required if hiring skiing/boarding equipment.Shoe size:Only required if hiring skiing/boarding equipment.
