Clarendon Girls’ High School – Consent & Indemnity

Medical Conditions & Medical Aid Details

Learner Full Name and Surname: Grade: Class: Date of Birth: Medical Aid: Medical Scheme: Medical Aid Number: Principal Member (Full Name): Principal Member’s I.D.: Parent Contact Details:

Medical Practitioner Details:

Does your daughter/ward have any medical condition or allergy of which the teachers accompanying the group need to be aware of? If yes, please give details of condition:

It is the responsibility of the parent/legal guardian to pay for any medical bills that the Medical Aid does not cover.
It is the responsibility of the parent/legal guardian to ensure that payment is received by the Finance Office by no later than the payment date referred to above failing which, the School reserves the right to exclude your daughter / ward from participating in the tournament.

Indemnity

I, the undersigned, do hereby give formal consent for my daughter / ward to participate in all activities organized, supervised and / or authorized by Clarendon Girls’ High School (hereinafter referred to as “the School”). I hereby acknowledge liability for any losses, damages, expenses (including medical expenses), costs, legal fees and disbursements which may be suffered by the school, myself and / or daughter / ward, arising from injury, death, harm or loss suffered as a result of her participating in any activity of the School, including tours of whatsoever nature, sporting, social and recreational activities, including travelling to and from any venue, UNLESS such a loss is caused by the negligence, wilfulness or deliberate act of the School or one or more of its employees. Furthermore, I confirm I am the legal guardian, and in my capacity as legal guardian, I grant the school permission to act on my behalf in securing medical treatment in the event of a medical emergency.

I confirm that I have read, understood, and agree to the indemnity and consent terms above.

Parent / Guardian Signature

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Verification

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