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Parental Consent Form International School Moshi


									                                                                          Parental Consent Form for M5 and Diploma Boarding Students
                                                                                                 School Year 2012/2013
                                               The Consent form is to help boarding parents make informed decisions, and should be updated each year. All privileges are at the
                                                                                              discretion of the boarding staff.
                                                                            Please read the Boarding Handbook before completing this form.

STUDENT’S NAME:                                                                         CLASS:

                         Please place a tick  in the box of your choice:
SCHOOL BANK                                                                                         INTERNET AND SCHOOL TRIPS
1                                                                                                                                                                           YES    NO
    My child may withdraw up to TSh____________ per week from the school bank.                                                                                                    
    We recommend pocket money of 6,000/= to 15,000/= per week. Funds for OP trips,                   9    My child may have unsupervised access to the Internet
    approximately $30 to $60 per trip, may be kept in a separate account if required.                     under conditions specified by the school.
                                                                                   YES     NO        10   My child may take part in trips arranged by people or
TRANSPORT                                                                                               organisations which are not run by the school
2   My child may use a taxi to and from:                  (i) Moshi town
                                                              (ii) Arusha                            11   Declaration:
                                                             (iii) Airport                                I authorise the boarding staff to sign permission forms for school organised
                                                             (iv) Anywhere                                trips as follows
3   My child may use public buses to & from:              (i) Moshi town                             a    Educational trips in Tanzania
                                                              (ii) Arusha                            b    Educational trips beyond Tanzania
                                                             (iii) Airport                           c    Other school trips (camping, mountain, sports) in Tanzania
                                                                                                     d    Other school trips (camping, mountain, sports) beyond
                                                             (iv) Anywhere
4   I allow ISM to provide transport to and from the airport at regular cost
    set by ISM.
                                                                                                     WEEKEND AND HOLIDAY INVITATIONS:
5   My child may accept lifts from members of the teaching staff                                     12   When students accept weekend or holiday invitations with other families,
6   My child may accept lifts from the parents or employed drivers of other                               we cannot guarantee the degree of supervision they may receive. You
    students at the discretion of the boarding staff.   (i) In Moshi area                                 may therefore wish to communicate directly with parents they wish to
                                                                                                          sign out to, and then confirm with us that it is a satisfactory arrangement.
                                                        (ii) To & from Arusha
                                                                                                                 PLEASE CHECK EITHER A OR B (NOT BOTH)
                                                          (iii) Anywhere                             A    My child may, without my specific confirmation, accept            YES    NO
7   My child may accept lifts from any other driver at the discretion of the                              invitations to visit / stay over with any families of other             
    school’s administration.                                                                              students:                                       (i) in Moshi
8   My child may go off campus unsupervised during the afternoon to visit                                                                                 (ii) in Arusha
    local shops or restaurants that are approved by the school. (The school                                                                               (iii) anywhere
    has its own shop, which supplies most of the students’ needs)..                                                                      OR
9   ONLY FOR DIPLOMA (D1 and D2) STUDENTS                                                            B    My child may only accept invitations if I have pre-confirmed
    My child may visit local shops or restaurants, approved by school,                                                                                                      YES    NO
                                                                                                          the arrangement personally.
    unsupervised on a weekend evening at the discretion of the Boarding                                                                                                             .
                                                                                                          However, I hereby confirm in advance that my child may
    staff. Trips will be a maximum of 4 hours, there must be at least 3 students
                                                                                                          accept invitations to the families listed here:
    and they must return by the designated time.
13   Holiday accommodation before and after term time.                          YES   NO   14   FOR RESIDENTS IN THE AREA ONLY                                                         YES   NO
     The school cannot offer boarding facilities to students before the start                                                                                                             
     or after the end of term. Please state what arrangements you wish                           (i) My child will return home (eg. to Arusha/Marangu) every weekend to stay at
     to make in the event that the student arrives before the start or                          home from Friday to Sunday. I guarantee to advise the boarding parent in
     departs after the end of term or during half term breaks.                                  advance of any weekend when my child plans to stay in school or travel
     (i) I will book/arrange accommodation for my child and inform                              elsewhere.
     (ii) I will let my child arrange his/her own accommodation                                 (ii) My child will stay in school every weekend unless specifically given permission
                                                                                                to travel elsewhere

I have completed this parental consent form after reading and understanding the Boarding Handbook. Any changes to the information on this consent form may only be made by
the parent or guardian whose signature appears on this form.

(Signature of parent/ guardian)                                                  (Date)

       CONTACT INFORMATION (Parent/guardian)                           LOCAL GUARDIAN                                            EMERGENCY CONTACT
          PLEASE GIVE YOUR CURRENT EMAIL                                                                                          Where possible, please give us the name and
        ADDRESS AS REGULAR COMMUNICATION                                                                                         address of a family in the Moshi or Arusha area
         FROM SCHOOL WILL NORMALLY BE BY                                                                                            who can be contacted in the event of an
                       EMAIL                                                                                                                       emergency.

       NAME:                                                           NAME:                                                     NAME:

       ADDRESS:                                                        ADDRESS:                                                  ADDRESS:

       LANDLINE:                                                       LANDLINE:                                                 LANDLINE:

       MOBILE:                                                         MOBILE:                                                   MOBILE:

       FAX:                                                            FAX:                                                      FAX:

       Email:                                                          Email:                                                    Email:

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