Active Education Consent Seymour 2026 Dietary and Medical

CAMP ATTENDEE
DIETARY, MEDICAL
AND CONSENT FORM

Participant Information

Teacher/Adult Volunteer

Participant First Name *

Participant Last Name *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Relationship to Participant *

To ensure the participant has the best experience possible whilst on camp we need to ensure we have any necessary details regarding their dietary, medical and wellbeing requirements. Please read and fill in the following form carefully to aid in a safe and enjoyable camp experience.

To ensure you have the best experience possible whilst on camp we need to ensure we have any necessary details regarding your dietary requirements. Please read and fill in the following form carefully to aid in a safe and enjoyable camp experience.

How does your child feel about coming on camp? *

Dietary Restrictions/Allergies

To view detail of how Active Education handles severe food allergies see www.activeed.com.au/food-allergies

Food Related Allergy

Peanut/Tree Nut Allergy

Food Related Allergy to? *

Nut Allergy to? *

Food Related Anaphylaxis

Diabetic (Dietary section)

Food Related Anaphylaxis Details *

Diabetic Notes for Catering Staff *

Food Related Anaphylaxis Action Plan *

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Diabetic Management Plan *

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Milk/Dairy Protein Allergy

Coeliac

Lactose Intolerant

Gluten Intolerant (not Coeliac)

Fish/Seafood Allergy

Vegetarian/Halal etc.

Other

Vegetarian/Halal etc. Details *

Dietary Comments (Other Details) *

Medical Details

Non Food Anaphylaxis

Non Food Related Allergy

Non Food Anaphylaxis Details *

Non Food Allergy Details *

Non Food Anaphylaxis Management Plan *

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Further Allergy Details if required

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Upload not required if reaction is not anaphylactic

Adult Medical Information

Diabetes (Medical section)

Epilepsy/Seizures

Diabetes Management Notes for Program Staff *

Date of last Epilepsy/Seizure Event *

Diabetes Management Plan *

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Epilepsy/Seizure Care/Management Plan *

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Epilepsy/Seizures controlled by medication

Asthma

Behavioural

Asthma Management/Care Plan *

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Behavioural Issues Details *

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Behavioural Management Plan *

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Does the participant have a disability or diagnosis that we should be aware of to support their experience on camp?

Disability or Diagnosis details and information for Active Education staff *

Disability or Diagnosis details and information upload if desired

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Hearing Loss

Other Conditions

Other Conditions Details *

Form Legal Signatory Email Address *

Send code

Required for validation of signature

Active Education may contact me about camp or other events

By signing below I acknowledge that Active Education will provide my son/daughter with access to a variety of activities which will be supervised by employees of Active Education in collaboration with school staff. I understand that these activities may have inherent danger or risk involved and I acknowledge responsibility for my child participating inthese activities. I give permission for Active Education to provide details from this form to my childs school. I understand that some Active Education programs include water based activities such as swimming and/or kayaking. I understand that should the school provide any additional forms for activities such as those provided by the Department for Education these forms must be provided to the school by prior to camp or the student will be unable to take part in these activities.
To find out more about Active Education visit www.activeed.com.au/parents

By signing below I acknowledge that Active Education provide a variety of activities which will be supervised by employees of Active Education in collaboration with school staff. I understand that these activities may have inherent danger or risk involved and I acknowledge responsibility for myself and my safety when participating in these activities (where applicable by law). I give permission for the in this form to be provided to the school I am volunteering for/working with. I understand that some Active Education programs include water based activities such as swimming and/or kayaking.

Photo Consent (read below)

I, the undersigned, being the legal guardian of the child, hereby give explicit consent for Active Education to take and use photographs and/or video footage (including audio) of my child for the purposes of school activities, training, and promotional materials, including but not limited to, publications and marketing on the internet. This consent is not limited by a specific duration and will remain in effect until explicitly requested to be withdrawn, at which time best efforts will be made to remove its use. I understand that all media will be stored and protected in accordance with any applicable Australian privacy laws.

I give explicit consent for Active Education to take and use photographs and/or video footage (including audio) of myself for the purposes of school activities, training, and promotional materials, including but not limited to, publications and marketing on the internet. This consent is not limited by a specific duration and will remain in effect until explicitly requested to be withdrawn, at which time best efforts will be made to remove its use. I understand that all media will be stored and protected in accordance with any applicable Australian privacy laws.

Acknowledgement of Risk *

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