أ ءﺰﺠﻟا ﺔﻠﺣر ﻰﻠﻋ ﺔﻘﻓاﻮﻣ ةرﺎﻤﺘﺳا Excursion Consent Form Section A ةرﺎﻤﺘﺳلاا ﻩﺬه ﻰﻠﻋ ﺔﻘﺒﻄﻨﻤﻟا ﻞﻴﺻﺎﻔﺘﻟا ءﻞﻣ ﻰﺟﺮﻳُ ﺔﻳﺰﻴﻠﻜﻧلإا ﺔﻐﻠﻟﺎﺑ ﻩﺎﺼﻗأ ﺪﻋﻮﻣ ﻲﻓ ﺔﺳرﺪﻤﻟا ﻰﻟإ ﺎﻬﺗدﺎﻋإو ________________________ Date for permission note return تﺎﻴﺻﻮﺼﺨﻟا نﺄﺸﺑ نلاﻋإ (Privacy Advice) تﺎﻣﻮﻠﻌﻤﻟا مﺪَﺨﺘﺴﺗُ ﺔﻴﺼﺨﺸﻟا ﺔﻣﺪّﻘﻤﻟا ﺐﻧﺎﺟ ﻦﻣ ﻩﺬه ﺔﻘﻓاﻮﻤﻟا ةرﺎﻤﺘﺳا ﻰﻠﻋ ﺎﻳﺎﻀﻗو ﻞﺻاﻮﺘﻟاو ﺔﻣﺎﻌﻟا ةرادلإا ضاﺮﻏلأ ﺐﻳرﺪﺘﻟاو ﻢﻴﻠﻌﺘﻟا ةﺮﺋاد ﺔﻠﺣﺮﻟا ﻩﺬه ﻲﻓ كﺪﻟﻮﺑ ﺔﻘﻠﻌﺘﻤﻟا ىﺮﺧلأا شﺎﻌﻧلإا . ﻞﻴﺻﺎﻔﺘﻟا ﻞآ ءﻞﻤﺑ ﻚﻟ ﺎﻨﺘﻴﺻﻮﺗ ﻲﻓ دﺪﺸﻧ ﺎﻨﻧﺈﻓ ﻲﻋﻮﻃ تﺎﻣﻮﻠﻌﻤﻟا ﻩﺬه ﻢﻳﺪﻘﺗ نأ ﻊﻣو . نأ ذإ ﻚﺑ لﺎﺼﺗلاا رﺬّﻌﺗ اذإ كﺪﻟﻮﺑ ﺔﺻﺎﺨﻟا شﺎﻌﻧلإا ﻞﺋﺎﺴﻣ ﻞﺣ ﻖﻴﻌﻳ ﺪﻗ ﻚﻟﺬﺑ مﺎﻴﻘﻟا مﺪﻋ . ﺔﻨﻴﻣأ ةرﻮﺼﺑ تﺎﻣﻮﻠﻌﻤﻟا ﻩﺬه ﻆﻔﺣ يﺮﺠﻳ . ﻚﻨﻜﻤﻳو ﺔﺳرﺪﻤﻟﺎﺑ لﺎﺼﺗلاا ﻖﻳﺮﻃ ﻦﻋ ﺖﻗو يأ ﻲﻓ ﺎﻬﺤﻴﺤﺼﺗ وأ ﻞﻴﺻﺎﻔﺘﻟا ﻦﻣ يأ ﻰﻠﻋ علاﻃّلاا . ﻩﺎﻧدأ ﺐﺳﺎﻨﻤﻟا ﻊﺑﺮﻤﻟا ﻲﻓ ةرﺎﺷإ ﻊﺿو ﻰﺟﺮﻳُ : (Please tick the appropriate boxes below:) ﻩﺎﻧدأ ﺎﻬﻠﻴﺻﺎﻔﺗ ﺔﻨﻴّﺒﻤﻟا ﺔﻣدﺎﻘﻟا ﺔﻴﺳرﺪﻤﻟا ﺔﻠﺣﺮﻟا ﻲﻓ يﺪﻟو ﺔآرﺎﺸﻣ ﻰﻠﻋ ﻖﻓاوأ . (I consent to my child participating in the forthcoming school excursion, the details of which appear below.) □ لا ﻠﺣﺮﻟا ﻲﻓ يﺪﻟو ﺔآرﺎﺸﻣ ﻰﻠﻋ ﻖﻓاوأ ﺔﻣدﺎﻘﻟا ﺔﻴﺳرﺪﻤﻟا ﺔ . (I do not consent to my child participating in the forthcoming school excursion.) □ ﺔﺋرﺎﻄﻟا تلاﺎﺤﻟا ﻲﻓ ﻲﺒﻄﻟا جلاﻌﻠﻟ يﺪﻟو ﻲﻘّﻠﺗ ﻰﻠﻋ ﺔﻘﻓاﻮﻤﻟا ﻲﻄﻋأ . (I give permission for my child to receive medical treatment in case of emergency.) □ ﺔﺋرﺎﻄﻟا تلاﺎﺤﻟا ﻲﻓ ﻲﺒﻄﻟا جلاﻌﻠﻟ يﺪﻟو ﻲﻘّﻠﺗ ﻰﻠﻋ ﺔﻘﻓاﻮﻤﻟا ﻲﻄﻋأ لا . (I do not give permission for my child to receive medical treatment in case of emergency.) □ ﺔﻟلاﺪﻠﻟ ةرﺎﻤﺘﺳلاا ﻊﻴﻗﻮﺗو ﻩﺎﻧدأ ﻊﺑﺮﻤﻟا ﻲﻓ كﺪﻟو ﻢﺳا ﺐﺘﻜﺗ نأ ءﺎﺟﺮﻟا ﺔﻠﺣﺮﻟا ﻲﻓ كﺪﻟو ﺔآرﺎﺸﻣ ﻰﻠﻋ ﻖﻓاﻮﺗ ﻢﻟ اذإ ﻚﻧأ ﻰﻟإ ﻩﺎﺒﺘﻧلاا ﻰﺟﺮﻳُ ﺔﺳرﺪﻤﻟا ﻰﻟإ رﺎﻌﺷلإا اﺬه ةدﺎﻋإو ﺎﻬﺘﻴﻘّﻠﺗ ﻚﻧأ ﻰﻠﻋ . ﺔﻠﺣﺮﻟا ﻞﻴﺻﺎﻔﺗ (Excursion Details) ﺪﻟﻮﻟا ﻢﺳا ﺐﺘآا . (Insert child’s name.) آا ﺦﻳرﺎﺗ ﺐﺘ / ﺔﻠﺣﺮﻟا ﺦﻳراﻮﺗ . (Insert date/s of excursion.) ﺔﻠﺣﺮﻟا نﺎﻜﻣ ﺐﺘآا . (Insert place of excursion.) ﺔﻠﺣﺮﻟا ﺔﻔﻠﻜﺗ ﺖﻘﻓرأ ﺪﻘﻟ . (I have enclosed the cost of the excursion.) $ ) ﻖﻓﺮﻣ ﻲﻟﺎﻤﺟلإا ﻎﻠﺒﻤﻟا ( □ ﺔﻠﺣﺮﻟا ﺔﻔﻠﻜﺗ ﻖﻓرأ ﻢﻟ . (I have not enclosed the cost of the excursion.) □ مﻮﻨﻟا ﻦﻤّﻀﺘﺗ ﻲﺘﻟا ﺔﻠﺣﺮﻟﺎﺑ صﺎﺨﻟا دﺮﻟا ﺖﻠﻤآأ جرﺎﺨﻟا ﻲﻓ (I have completed the overnight excursions response.) □ جرﺎﺨﻟا ﻲﻓ مﻮﻨﻟا ﻦﻤّﻀﺘﺗ ﻲﺘﻟا ﺔﻠﺣﺮﻟﺎﺑ صﺎﺨﻟا دﺮﻟا ﻖﺒﻄﻨﻳ لا (The overnight excursions response does not apply.) □ ا دﺮﻟا ﺖﻠﻤآأ ﺔﺣﺎﺒﺴﻟا وأ ﺔﻴﺋﺎﻤﻟا ﺔﻄﺸﻧلأﺎﺑ صﺎﺨﻟ . (I have completed the water or swimming activities response.) □ ﺔﺣﺎﺒﺴﻟا وأ ﺔﻴﺋﺎﻤﻟا ﺔﻄﺸﻧلأﺎﺑ صﺎﺨﻟا دﺮﻟا ﻖﺒﻄﻨﻳ لا . (The water or swimming activities response does not apply.) □ ﺮﻔﺴﻟا ﻦﻴﻣﺄﺘﺑ صﺎﺨﻟا دﺮﻟا ﺖﻠﻤآأ . (I have completed the travel insurance response.) □ ﺮﻔﺴﻟا ﻦﻴﻣﺄﺘﺑ صﺎﺨﻟا دﺮﻟا ﻖﺒﻄﻨﻳ لا . (The travel insurance response does not apply.) □ ءﻞﻣ ﻲّﻠﻋو ﺔﻠﺣﺮﻟا ﻩﺬﻬﻟ ﺔﺻﺎﺧ ﺔﻴﺒﻃ تﺎﺟﺎﻴﺘﺣا يﺪﻟﻮﻟ ﺔﻴﺒﻄﻟا تﺎﻣﻮﻠﻌﻤﻟا ةرﺎﻤﺘﺳا . (My child has special medical requirements for this excursion and I must complete the Medical Information Form.) □ ﺔﻠﺣﺮﻟا ﻩﺬﻬﻟ ﺔﺻﺎﺧ ﺔﻴﺒﻃ تﺎﺟﺎﻴﺘﺣا ﺔﻳأ يﺪﻟﻮﻟ ﺲﻴﻟ . (My child does not have any special medical requirements for this excursion.) □ ﺔﻳﺎﻋﺮﻟا مﺪّﻘﻣ وأ ﺪﻟاﻮﻟا ﻊﻴﻗﻮﺗ __________________________________________________________ Signature of parent or caregiver ARABIC