Form
Form
MPUMALANGA DEPARTMENT OF EDUCATION 1
1
PERMISSION LETTER
I, (full name of parent / guardian)
…………………………………………………………. of (give full address)
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………….…….
parent of (full name of learner):
…………………………………………………………………………………..
of
………………………………………………………………………………………………………
……………… (school)
hereby agree that my child may take part in the camp initiated by the
Mpumalanga Department of Education.
I hereby appoint / authorise the organisers to act in my place as a parent
(guardian) and if necessary, to consent to my child undergoing any surgical
or other medical treatment. I undertake to pay the cost of such treatment
where required. I fully understand and accept that all activities are
undertaken at my child’s own risk.
I am aware that the Department of Education accepts no responsibility for
any loss, injury or damage to the person or property of my child which may
be sustained whilst engaged in any of the Camp activities, and which cannot
be attributed to negligence of the staff responsible.
Signed in (place):
………………………………………………………………………………………………………
……….
Signature of Parent / Guardian:
………………………………………………………………………………………
Date: ………………………………
Signature of witness:
………………………………………………………………………………………………………
.
Date: ………………………………
Form
Form
2
2
INDEMNITY FORM
A. I, ………………………………………………………………………… (full name
of parent / guardian), the parent of …………………………………………
……………………………(full name, surname and ID of learner)
hereby give permission for her to participate in the Maths, Science
and Technology Camp 2024.
B. I accept that all reasonable precautions will be taken to ensure the
safety and welfare of my child and shall be held responsible for the
payment of medical and / or hospital accounts, where applicable,
should an injury be sustained which cannot be ascribed to negligence
on the part of the staff responsible.
C. I cede the powers as parent / guardian to the Co-ordinator or her
representatives should medical treatment / surgery be deemed
necessary for my child. As far as I know she is capable of
participating in the activities and is in good health.
D. However, the persons responsible should please note the following:
(Please state aspects that the teaching staff should be aware of. E.g.
allergies, tendency towards abnormal bleeding, epilepsy, etc.)
E. The following information is essential in case of medical treatment or
hospitalisation:
Name of Medical Aid fund:
Residential address of Parent / Guardian:
Telephone numbers (of parent / guardian):
(Home): (Work):
Cell:
Signature of parent / guardian:
Identity number:
Date:
Form
Form
3
3
HEALTH CERTIFICATE
I certify that, to the best of my knowledge, my child,
(Name)
………………………………………………………………………………………………………
………………………
A. is not suffering from any physical disability or illness which makes it
inadvisable for her to attend the camp, or other activities, but I wish
to draw your attention to the following: (please state clearly)
e.g. wears glasses, has allergies (say what), suffers from asthma, has
a special diet (specify), etc.
…………………………………………………………………………………………
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B. is not suffering from any infectious disease, and has not been in
contact with anyone suffering from infectious diseases during the
past 14 days.
PARENT / GUARDIAN (Please print Name and Surname):
………………………………………………………………………………………………
……………………
Signature: …………………………………… (Parent / Guardian)
Date: ……………………………………
Telephone numbers: (Work): ………………………………………
(Home / Neighbour): …………………………………………
Cellular: : ………………………………………..
