AT WALK PW OO Info Consent Form Parents Carers by r16lFE


									     Information for
     Parent / Carer
                                              Walk to School Day
                                              Wednesday 24 October 2012

Download the Information for Parent / Carer and Consent Form and adapt it for
your school.

 Instructions for Parent / Carer

 1. Carefully read through this information.
 2. Retain this page for your family to keep.
 3. Complete and return consent form attached to your school by: RETURN DATE HERE

 Purpose of the activity
 Walk to School Day is a Walk Over October event coordinated by the Heart
 Foundation in partnership with the State Government to encourage West Australian
 school children and their families to walk part or all of the way to school on
 Wednesday 24 October 2012.

 Activities to be conducted
 West Australian school students will be encouraged to walk to school on Wednesday
 24 October 2012. Participating schools receive merchandise, activity kits and
 promotional materials.

 Wednesday 24 October 2012

 Walking from home to school or from a drop-off point (designated by parent/carer) to

 It is strongly recommended that students under 10 years are accompanied to school
 by a parent or carer. Children under the age of 10 are considered vulnerable road
 users because they can be easily distracted and have difficulty judging the speed and
 distance of approaching traffic. Parents/Carers should consider their child’s level of
 development for this activity.

 For your child to participate in Walk to School Day, a parent / carer must complete
 and return the signed consent form attached.

 To ensure the safety of your child on the day:

    You are required to inform the school about any changes to regarding your child’s
     participation prior to this event.
    The school will acknowledge the arrival of your child by marking them on a
     Classroom Roll.
    The school will contact you immediately if there are any concerns.
    Consent Form

                                            Walk to School Day
                                            Wednesday 24 October 2012

Please sign and return to: (Insert your School Name) By: (Insert Date)

          Parent / Carer contact information – Walk to School Day

Name: _____________________________________________________________

Home: ___________________ Work: _______________ Mobile: ______________

Best number reached on between 8am and 9am: ___________________________

I have read and understood the information regarding Walk to School Day on
Wednesday 24 October 2012 and give my consent for my son / daughter to
participate. (Please print)

Student’s First Name:__________________ Surname: ______________ Age: ______

Place a TICK in one of the boxes below:

            will walk to school with: ________________________________________

            will walk to school on his/her own.

Notes: (For teacher from parent / carer) _________________________________


Signature of parent / carer: _____________________ Date: ______________

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