FORM E3 Year 11 IYA Bronze Trekking Trip October 2010.

2010/11 PARENTAL APPROVAL FORM FOR OVERNIGHT FIELD TRIP

(Student's Name) _____________________ (Homeroom) _____ has my permission to

participate on a IYA Bronze Trekking Expedition to Pak Chong. The students are
travelling by Mini Vans. They will leave the school on:

Saturday 16th October 2010 – Depart

Sunday 17th October 2010 - Return

The field trip will be under the supervision of the following NIST staff members:
Mr. Graham Wardle/Mr Neil Commons Trip Leaders

Student's emergency home or contact numbers:

Home _________________________ Mobile _________________________

Business ________________________ Mobile _________________________
Please respond to the following questions as appropriate:
1. Is the student on any personal medication?
Yes  No 
If yes – Detail the medication, dosage, time etc.

____________________________________________________________
____________________________________________________________
2. Does the student have any dietary restrictions?
Yes  No 
Details ______________________________________________________
3. Detail the swimming ability of your child
Non swimmer  Beginner  Moderate  Strong 
4. To the best of your knowledge, has your son/daughter been in contact with any
contagious or infectious diseases or suffered from anything in the last four weeks
that may be contagious or infectious? YES/NO
If YES, please give brief details _________________________________________

Student Commitment
I understand that as a student of NIST I am expected to abide by all NIST rules
regarding possession and use of tobacco products, alcohol and other non prescriptive
drugs as outlined in the Student Handbook. The consequence of not abiding by these
rules may involve me being sent home from the field trip at my family’s expense and/or
suspension. A worse case scenario may even involve recommended expulsion.

I will also display common courtesy in behaviour, language, attitude and manners on
this trip as well as adhere to any other guidelines required by the chaperones.

Student Name: ………………………………….. Signature: ……………………………

Year: ……………….. Date: ……………………….

Please Turn Over

Provided all due supervision by teachers is properly organised and carried out, I recognise
as parent/guardians of the above student that neither the school nor NIST staff members will
be held responsible for any accident or other unexpected event, nor for events arising from
the above student disobeying instructions.

I agree that if the student fails to follow the directions of the staff that I will arrange to collect
my child from the field trip / activity site at my own expense.

In addition, I give my permission for any necessary medical attention to be administered as

deemed necessary if I cannot be contacted beforehand.

Overnight Field Trips are governed by the Rules and Regulation of the Ministry of
Education.

PARENT / GUARDIAN'S NAME (PRINT) _____________________________________

(Signature) _________________________ (Date) _________________________

***Field Trips are a part of the school curriculum. All students are encouraged to participate.
Parents/students who have committed to a field trip will be invoiced for all non-refundable
costs associated with the trip in case of absence.***

Insurance:
The New International School of Thailand has a supplementary Personal Accident/ Medical Cover
Policy that applies to any official school trip that includes an over-night stay.
On these occasions (overnight trips) the Medical Cover is 160,000 baht for short term emergency
medical expenses, 200,000 Baht for death/disability and 50,000 baht for emergency medical
evacuation.
Parents are strongly advised to check whether these amounts are satisfactory for their personal 
circumstances and arrange additional insurance if they so desire.  Any amounts in excess of the
above must be paid for by the parents. The signing of the consent form indicates that you as a parent
understand that the school’s liability is limited to the above sums.

I am aware that all students on Field Trips are required to have private insurance, which is
the responsibility of the parents to arrange. My child has insurance

with ________________________________________________(insurance company),

Policy No._____________________________________________________________

Policy renewal date._____________________________________________________

Return this completed form to: Khun Pare, Secondary Secretary

By: Friday 17th September 2010.