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Accompanying adults details form

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Please include all visiting teachers and adult helpers on this form and indicate their delegation, their Blue Card accreditation and any medical considerations, which the teaching staff need to be aware of.

Two (2) copies must be brought with you on the day of your excursion, unless you are completing the online form below.

Important

The following details MUST be included when completing the form:

Names of accompanying adults and their delegation
Whether they are a Blue Card holder or hold an exemption
Any pre-existing medical conditions.

Privacy Statement

The Department of Education through Nudgee Beach Environmental Education Centre is collecting personal information in accordance with Education (General Provisions) Act 2006 in order to maintain our records. The information will only be accessed by Department of Education. The information will not be given to any other person or agency unless consent is provided.

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Accompanying adults details form

School

Booking number

Name 1

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 2

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 3

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 4

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 5

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 6

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 7

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 8

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 9

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 10

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 11

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 12

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 13

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 14

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 15

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 16

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 17

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 18

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 19

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

Name 20

Name | Delegation i.e. Teacher/Parent/Staff | Blue Card holder / Exempt | Medical conditions (if applicable)

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Last reviewed 27 July 2021

Last updated 27 July 2021