Westlake Symphony Orchestra Camp

7th 9th April 2017

Permission, Dietary and Medical Information Sheet

Student _______________________________ Form ______________

I/We give permission for my/our daughter/son to attend Westlake Symphony

Orchestra Camp from Friday 7th April Sunday 9th April 2017 at Willow Park Christian
Camp, 1 Hostel Access Road, Eastern Beach, Auckland 2012.
(Ph: 09-534 9640)

I/We authorise the obtaining on my/our behalf, any medical assistance or treatment if,
in the opinion of the staff, such treatment is necessary and I/we agree to meet all costs
and fees incurred. Every endeavour will be made to contact Parents/Guardians first.

I/We understand and agree that Westlake High Schools or its staff will not accept
responsibility for loss or damage to personal property.

Signed (Parent/Caregiver) ___________________________ Date ______________

Allergies: ___________________________________________________
___________________________________________________
Medication: ___________________________________________________
___________________________________________________

Emergency
Contact: Name ___________________________________

Phone ___________________________________

Vegetarian: Yes No please tick one box

Other Dietary
Requirements: ___________________________________________________

___________________________________________________

Students: I agree to abide by the school rules at all times while at camp.

Signed ________________________________

The Emergency Contact person MUST be able to be contacted at ALL times during
the period of the camp (7th 9th April 2017)

This form can be handed in or scanned and emailed to Mrs Clarke by Tuesday 28th March
2016. mclarke@westlakegirls.school.nz