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 n