ARABIC
اﺳﺘﻤﺎرة ﻣﻮاﻓﻘﺔ ﻋﻠﻰ رﺣﻠﺔ اﻟﺠﺰء أ
Excursion Consent Form Section A ُﺮﺟﻰ ﻣﻞء اﻟﺘﻔﺎﺻﻴﻞ اﻟﻤﻨﻄﺒﻘﺔ ﻋﻠﻰ هﺬﻩ اﻻﺳﺘﻤﺎرة ﺑﺎﻟﻠﻐﺔ اﻹﻧﻜﻠﻴﺰﻳﺔ وإﻋﺎدﺗﻬﺎ إﻟﻰ اﻟﻤﺪرﺳﺔ ﻓﻲ ﻣﻮﻋﺪ أﻗﺼﺎﻩ ﻳ
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Date for permission note return
إﻋﻼن ﺑﺸﺄن اﻟﺨﺼﻮﺻﻴﺎت )(Privacy Advice ُﺴﺘﺨ َم اﻟﻤﻌﻠﻮﻣﺎت اﻟﺸﺨﺼﻴﺔ اﻟﻤﻘ ّﻣﺔ ﻋﻠﻰ اﺳﺘﻤﺎرة اﻟﻤﻮاﻓﻘﺔ هﺬﻩ ﻣﻦ ﺟﺎﻧﺐ داﺋﺮة اﻟﺘﻌﻠﻴﻢ واﻟﺘﺪرﻳﺐ ﻷﻏﺮاض اﻹدارة اﻟﻌﺎﻣﺔ واﻟﺘﻮاﺻﻞ وﻗﻀﺎﻳﺎ ﺪ ﺗ ﺪ اﻹﻧﻌﺎش اﻷﺧﺮى اﻟﻤﺘﻌﻠﻘﺔ ﺑﻮﻟﺪك ﻓﻲ هﺬﻩ اﻟﺮﺣﻠﺔ. وﻣﻊ أن ﺗﻘﺪﻳﻢ هﺬﻩ اﻟﻤﻌﻠﻮﻣﺎت ﻃﻮﻋﻲ ﻓﺈﻧﻨﺎ ﻧﺸﺪد ﻓﻲ ﺗﻮﺻﻴﺘﻨﺎ ﻟﻚ ﺑﻤﻞء آﻞ اﻟﺘﻔﺎﺻﻴﻞ. إذ أن ﻋﺪم اﻟﻘﻴﺎم ﺑﺬﻟﻚ ﻗﺪ ﻳﻌﻴﻖ ﺣﻞ ﻣﺴﺎﺋﻞ اﻹﻧﻌﺎش اﻟﺨﺎﺻﺔ ﺑﻮﻟﺪك إذا ﺗﻌ ّر اﻻﺗﺼﺎل ﺑﻚ. ﻳﺠﺮي ﺣﻔﻆ هﺬﻩ اﻟﻤﻌﻠﻮﻣﺎت ﺑﺼﻮرة أﻣﻴﻨﺔ. وﻳﻤﻜﻨﻚ ﺬ اﻻ ّﻼع ﻋﻠﻰ أي ﻣﻦ اﻟﺘﻔﺎﺻﻴﻞ أو ﺗﺼﺤﻴﺤﻬﺎ ﻓﻲ أي وﻗﺖ ﻋﻦ ﻃﺮﻳﻖ اﻻﺗﺼﺎل ﺑﺎﻟﻤﺪرﺳﺔ. ﻃ ُﺮﺟﻰ وﺿﻊ إﺷﺎرة ﻓﻲ اﻟﻤﺮﺑﻊ اﻟﻤﻨﺎﺳﺐ أدﻧﺎﻩ: ):(Please tick the appropriate boxes below ﻳ
(I consent to my child participating
أواﻓﻖ ﻋﻠﻰ ﻣﺸﺎرآﺔ وﻟﺪي ﻓﻲ اﻟﺮﺣﻠﺔ اﻟﻤﺪرﺳﻴﺔ اﻟﻘﺎدﻣﺔ اﻟﻤﺒ ّﻨﺔ ﺗﻔﺎﺻﻴﻠﻬﺎ أدﻧﺎﻩ. ﻴ
).in the forthcoming school excursion, the details of which appear below
□ □ □ □
(I do not consent to my child participating in the
ﻻ أواﻓﻖ ﻋﻠﻰ ﻣﺸﺎرآﺔ وﻟﺪي ﻓﻲ اﻟﺮﺣﻠﺔ اﻟﻤﺪرﺳﻴﺔ اﻟﻘﺎدﻣﺔ.
).forthcoming school excursion
اﻟﻄﺎرﺋﺔ. (I give permission for my child to receive
أﻋﻄﻲ اﻟﻤﻮاﻓﻘﺔ ﻋﻠﻰ ﺗﻠ ّﻲ وﻟﺪي ﻟﻠﻌﻼج اﻟﻄﺒﻲ ﻓﻲ اﻟﺤﺎﻻت ﻘ
).medical treatment in case of emergency
اﻟﻄﺎرﺋﺔ. (I do not give permission for my child to
ﻻ أﻋﻄﻲ اﻟﻤﻮاﻓﻘﺔ ﻋﻠﻰ ﺗﻠ ّﻲ وﻟﺪي ﻟﻠﻌﻼج اﻟﻄﺒﻲ ﻓﻲ اﻟﺤﺎﻻت ﻘ
).receive medical treatment in case of emergency
ُﺮﺟﻰ اﻻﻧﺘﺒﺎﻩ إﻟﻰ أﻧﻚ إذا ﻟﻢ ﺗﻮاﻓﻖ ﻋﻠﻰ ﻣﺸﺎرآﺔ وﻟﺪك ﻓﻲ اﻟﺮﺣﻠﺔ اﻟﺮﺟﺎء أن ﺗﻜﺘﺐ اﺳﻢ وﻟﺪك ﻓﻲ اﻟﻤﺮﺑﻊ أدﻧﺎﻩ وﺗﻮﻗﻴﻊ اﻻﺳﺘﻤﺎرة ﻟﻠﺪﻻﻟﺔ ﻳ ﻋﻠﻰ أﻧﻚ ﺗﻠ ّﻴﺘﻬﺎ وإﻋﺎدة هﺬا اﻹﺷﻌﺎر إﻟﻰ اﻟﻤﺪرﺳﺔ. ﻘ
ﺗﻔﺎﺻﻴﻞ اﻟﺮﺣﻠﺔ )(Excursion Details
اآﺘﺐ اﺳﻢ اﻟﻮﻟﺪ.
).(Insert child’s name
اآﺘﺐ ﺗﺎرﻳﺦ/ﺗﻮارﻳﺦ اﻟﺮﺣﻠﺔ.
).(Insert date/s of excursion
اآﺘﺐ ﻣﻜﺎن اﻟﺮﺣﻠﺔ.
).(Insert place of excursion
ﻟﻘﺪ أرﻓﻘﺖ ﺗﻜﻠﻔﺔ اﻟﺮﺣﻠﺔ.
).(I have enclosed the cost of the excursion
□ □ □ □ □
ﻟﻢ أرﻓﻖ ﺗﻜﻠﻔﺔ اﻟﺮﺣﻠﺔ.
).(I have not enclosed the cost of the excursion
□ □ □ □ □
$
)اﻟﻤﺒﻠﻎ اﻹﺟﻤﺎﻟﻲ ﻣﺮﻓﻖ(
أآﻤﻠﺖ اﻟﺮد اﻟﺨﺎص ﺑﺎﻟﺮﺣﻠﺔ اﻟﺘﻲ ﺗﺘﻀ ّﻦ اﻟﻨﻮم ﻤ ﻓﻲ اﻟﺨﺎرج
(I have completed the overnight excursions ).response
ﻻ ﻳﻨﻄﺒﻖ اﻟﺮد اﻟﺨﺎص ﺑﺎﻟﺮﺣﻠﺔ اﻟﺘﻲ ﺗﺘﻀ ّﻦ اﻟﻨﻮم ﻓﻲ اﻟﺨﺎرج ﻤ
).(The overnight excursions response does not apply
أآﻤﻠﺖ اﻟﺮد اﻟﺨﺎص ﺑﺎﻷﻧﺸﻄﺔ اﻟﻤﺎﺋﻴﺔ أو اﻟﺴﺒﺎﺣﺔ.
(I have completed the water or swimming activities ).response
ﻻ ﻳﻨﻄﺒﻖ اﻟﺮد اﻟﺨﺎص ﺑﺎﻷﻧﺸﻄﺔ اﻟﻤﺎﺋﻴﺔ أو اﻟﺴﺒﺎﺣﺔ.
(The water or swimming activities response does not ).apply
أآﻤﻠﺖ اﻟﺮد اﻟﺨﺎص ﺑﺘﺄﻣﻴﻦ اﻟﺴﻔﺮ.
).(I have completed the travel insurance response
ﻻ ﻳﻨﻄﺒﻖ اﻟﺮد اﻟﺨﺎص ﺑﺘﺄﻣﻴﻦ اﻟﺴﻔﺮ.
).(The travel insurance response does not apply
ﻟﻮﻟﺪي اﺣﺘﻴﺎﺟﺎت ﻃﺒﻴﺔ ﺧﺎﺻﺔ ﻟﻬﺬﻩ اﻟﺮﺣﻠﺔ وﻋﻠﻲ ﻣﻞء ّ
اﺳﺘﻤﺎرة اﻟﻤﻌﻠﻮﻣﺎت اﻟﻄﺒﻴﺔ.
ﻟﻴﺲ ﻟﻮﻟﺪي أﻳﺔ اﺣﺘﻴﺎﺟﺎت ﻃﺒﻴﺔ ﺧﺎﺻﺔ ﻟﻬﺬﻩ اﻟﺮﺣﻠﺔ.
(My child does not have any special medical requirements ).for this excursion
(My child has special medical requirements for this excursion and I must complete the Medical ).Information Form
ﺗﻮﻗﻴﻊ اﻟﻮاﻟﺪ أو ﻣﻘ ّم اﻟﺮﻋﺎﻳﺔ__________________________________________________________ ﺪ
Signature of parent or caregiver