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  • Ashmore State School

Medical consent form

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​The Department of Education through Ashmore State School is collecting personal information in accordance with Education (General Provisions) Act 2006 in order to maintain student medical consent 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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If you ticked any of the above conditions, you MUST complete the additional information sheet.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.
If yes, please provide details.

If your child has received a tetanus booster, please enter the year last given.
I understand that school staff can not administer over the counter medication, including analgesics, homeopathic or prescribed medication unless they meet the accountability of a written request from a parent / guardian accompanied by written advice from a medical practitioner and with the medication in the original labelled container.
Please tick to authorise the above.

Please give details including approximate timeframes.
If your child has any other additional details or conditions please outline.
Are there any custodial issues that the Principal and/or staff of Runaway Bay Sport and Leadership centre should be made aware of? If yes, please outline.




E.g. aunty / grandparent etc.

I hereby authorise the Principal, or his/her representatives, to obtain such medical attention as may be deemed necessary, and I understand the costs will be passed onto my child's school. I am responsible for reimbursing the school.
By ticking this button, I agree that all details above are true and correct.
Select a date from the calendar.
In the past photographs have been taken of students for school publications (e.g. Prospectus, handbooks, website) and occasional newspaper and television stories. Please indicate your willingness to allow your child's photograph to be taken for the purposes outlined.
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Last reviewed 27 July 2021
Last updated 27 July 2021