Student Excursion Acknowledgement - Sports Teams

STUDENT ACKNOWLEDGEMENT – For Members of Sports Teams
This acknowledgement is to be completed by each student who is a member of an ongoing team sport event such as (but not limited to) Football, Basketball, Table Tennis, Chess) . If the student is participating in more than one event then the form must be completed (only once) for each sport. It must be returned to the Staff Person in Charge prior to the commencement of the excursion(s). Please note that failure to submit this form may jeopardise the p articipant’s ability to attend the excursion. UOWD Women Basketball team
Name of Team/Sport __________________________________________________________________________

Anne Mugnier
Student Name: __________________________________________________________________________________________
PUNE INDIA
4354485
28/02-01/03
Student Number: ____________________ Excursion Destination: _______________________________ Date ________________

Please tick the relevant boxes and sign the form.
I have been provided with a copy of the General Excursion Information Notice and am aware of the foreseeable hazards associated with participating in this ongoing event .

x
 YES x  YES

I understand that all UOWD policies and rules apply during any authorised excursion. I understand that breech of policies or rules of conduct may result in disciplinary action.
I have/will seek appropriate medical advice regarding any medical condition(s) I have, or may develop and the risks associated with my participation on the excursion and have, if necessary a Medical Clearance to this effect. I have advised the excursion coordinator/supervisor of medical advice sought, that will assist in the management of my medical condition whilst away on the excursion

 NO
 NO

x
 YES

 NO

x
 YES

 NO

 N/A

x
 YES

 NO

 N/A

Transport to Excursion
I understand and accept that if I drive to or from an excursion, I will be travelling at