Prince of Peace Lutheran College

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Please complete this Medical Form at least 2 weeks prior to your child attending. If you have any issues please contact us. You can always fill out the form again if anything changes.

Student Details

Photos of your child may be taken as part of capturing the experience of camp and supplied back to the school for viewing by the students. Photos will be placed on the Mt Binga Facebook page, or the Mt Binga website. It may also be used for marketing purposes in the future. Please select your preference below.

Emergency Contact Details

Medicare/Private Health Information

Is your child up to date with all immunisations?

Dietary Needs

Medical Information

Psychological Conditions

Mt Binga acknowledges that the information pertaining to psychological and social/emotional conditions is sensitive. Due to the nature of the Mt Binga experience it is vital that staff are fully informed regarding students psychological needs. The information provided will be treated confidentially and only disclosed to staff members in order to assist them in providing a safe and supportive environment for students.

Psychological Conditions Continued

(e.g. psychologist, psychiatrist, GP)

Medical Professional

Do you give us permission to contact this profession if the need arises?

Medication

I authorise the Mt Binga staff to administer paracetamol as the need arises
I authorise the Mt Binga staff to administer ibuprofen as the need arises
I authorise the Mt Binga staff to administer antihistamine as the need arises

Swimming Ability

Any Other Information

Fields with a * are required