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The students are travelling by Bus and will leave the school at approximately 6:15am on Tuesday, November 20, 2012 and will return at approximately 1:00 pm. on Friday, November 23, 2012 The field trip will be under the supervision of NIST staff members including the Year 6 Teachers. A pupil - teacher ratio of 1-7 will be maintained. Please ensure the details below are duly completed and correct where necessary.
Student's emergency home or contact numbers:

Home_________________ Father work______________________ Mother Work______________________ Mobile ______________________ 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 familys expense and/or suspension. A worst 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: .. Year: ..

Signature: 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.

______________ has my permission to participate on Year 6 Camp Pung-Waan

Resort, Kanchanaburi On Tuesday, November 20 - Friday, November 23, 2012.

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.***

The New International School of Thailand has a supplementary Personal Accident/Medical Cover Policy. The policy is in place for emergency purposes, to the following value: 60,000 THB. 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: Homeroom teacher by Friday,

October 5th, 2012