LiverpoolPrimarySchoolSportsAssociation

LiverpoolZoneTrials Sport: U11’sRugbyLeagueConvener: MrGrantWithers(HammondvillePS)PleaseinformcapablestudentsthatLiverpoolZonewillbeholdingtrialsforU11’sRugbyLeague.--------------------------------------------------------------------------------------------------------------------------Date: Monday2ndMarch2020(2/3/20)Venue:WoodwardPark/HillierOvalTime:3.45to5.00pm.Cost:NilWhattobring:1. Appropriaterugbyclothesi.e.jersey,shorts,longsocksandboots2. Waterbottle3. Mouthguard4. Additionalgearoptionale.g.headgear,shoulderpads5. Completedpermissionnote.6. Ifapplicable,aHealthCareplanattachedtothisnote(oremailedtotheconvener

priortothetrial).DuetoWHSregulationsstudentswithoutacopyoftheirhealthcareplanwillNOTbeabletotrial.

Pleasefillinthefollowingpermissionnoteandbringittothetrials.Thanks,MrGrantWithers(HammondvillePS)

1. STUDENTDETAILSStudent’sname:_______________________________School:__________________DateofBirth:________________

2. MEDICALDETAILSMedicarenumber:_______________________________ Expiry:_______________Dateofmychild’slasttetanusinjection:_________________Mychildisallergicto_________________________________________________

DoesyourchildhaveanASCIAactionplan?Yes(acopymustbeattachedtothisform)

NoHasyourchildsufferedaheadinjury/concussioninthelast10days?

Yes(amedicalclearancemustbeattachedtothisform)No

Pleasedetailanymedicalorspecialneedswhichtheteammanagershouldbeawareof,includinganybehaviourmanagementorotherspecialisedplans(copiesofplanstobeattached).

____________________________________________________________________________________________________________________________________________________

IMPORTANTINFORMATION

Intheeventofinjury,nopersonalinjuryinsurancecoverisprovidedbytheNSWDepartmentofEducationforstudentsinrelationtoschoolsportingactivities,physicaleducationlessonsoranyotherschoolactivity.TheDepartment’spublicliabilitycoverisfaultbasedandlimitedtobreachesbythedepartmentofitsdutyofcaretostudentsthatmayresultinclaimsforcompensation.Parentsandcaregiversareadvisedtoassessthelevelandextentoftheirchild’sinvolvementinthesportprogramofferedbytheschool,schoolsportzone,regionandstateschoolsportassociationswhendecidingwhetheradditionalinsurancecoverisrequiredpriortotheirchild’sinvolvementintheprogram.Personalaccidentinsurancecoverisavailablethroughnormalretailinsuranceoutlets.

Parentswhohaveprivateambulancecoverneedtocheckwhetherthatcoverextendstointerstatetravelandmakeadditionalarrangementsasconsideredappropriate.TheNSWSupplementarySportingInjuryBenefitsScheme,fundedbytheNSWGovernment,provideslimitedcoverforseriousinjuryresultinginthepermanentlossofaprescribedfacultyortheuseofsomeprescribedpartofthebody.TheSupplementarySchemedoesnotcovermedicalexpensesordentalcosts.Furtherinformationcanbeobtainedfromwww.sportinginjuries.com.auFurtherinformationregardingstudentaccidentinsuranceandprivatehealthcoverisprovidedat:www.sports.det.nsw.edu.au/spguide/activities/general/resources/protection.php#medi

PRIVACYNOTICEThepersonalinformationprovidedonthispermissionnote,willbeusedbytheDepartmentofEducationforgeneraladministrationandcommunicationandothermattersofwelfarerelatingtoyourchildatthisevent.Theprovisionofthisinformationisvoluntarybutyourchildmaynotbeabletoparticipateifitisnotprovided.Thisinformationwillbestoredsecurelyandmaybeamendedatanytimebycontactingtheteammanagement.

PUBLISHINGSTUDENTINFORMATIONTheDepartmentofEducationmaypublishordiscloseinformationaboutyourchildforthepurposesofsharinghis/herexperienceswithotherstudents,informingtheschoolandbroadercommunity.Thisinformationmayincludeyourchild’sname,age,informationcollectedduringthiseventsuchasphotographs,sound&visualrecordingsofyourchild.Thecommunicationsinwhichyourchild’sinformationmaybepublishedordisclosedincludebutarenotlimitedto:

• PublicwebsitesoftheDepartmentofEducationincludingtheSchoolSportUnitwebsiteat—https://app.education.nsw.gov.au/sport/—theDepartmentofEducationintranet(staffonly),blogsandwikis.

• DepartmentofEducationpublicationsincludingtheschoolnewsletter,annualschoolmagazineandschoolreport,promotionalmaterialpublishedinprintandelectronicallyincludingontheDepartment’swebsites

• OfficialDepartmentandschoolsocialmediaaccountsonnetworkssuchasYouTube,FacebookandTwitter.

• Localandmetropolitannewspapersandmagazinesandothermediaoutlets.• Parentsshouldbeawarethatwheninformationispublishedonpublicwebsitesand

socialmediachannelsitcanbelinkedtobythirdpartiesandmaybediscoverableonlineforanumberofyears,ifnotpermanently.Searchenginesmayalsocacheorretaincopiesofpublishedinformation.

3. PERMISSIONTOPUBLISHIhavereadtheinformationaboutdisclosingandpublishingstudentinformationaboveand:IgivepermissionIdonotgivepermission4. PRINCIPAL’SDECLARATION

Permissionfromtheschoolhasbeengrantedfor___________________________toattendtheRegionalcarnival.

Signed(PrincipalorSchoolRepresentative)_________________________________

Date:________________Schoolstamp:

5. PARENT/CAREGIVERCONSENT• Iconsenttomychildparticipatinginthiseventunderthesupervisionof

TeamManager/sandinaccordancewiththeenclosedCodeofConduct.• Intheeventofanyaccidentorillness,Iauthorisetheobtaining,onmy

behalf,anambulanceandanysuchmedicalassistancethatmychildmayrequire.Iacceptfullresponsibilityforallexpensesincurred.

Signed(Parent/Caregiver:________________________Date:_____________Mobile:_____________________________