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HELENSBURGHPUBLICSCHOOL

STUDENTCONTACTDETAILS2012

DearParents

As our student records need to be updated on a regular basis, we request that all families complete the
followingdetailsandreturntotheschoolofficeNOLATERTHANFRIDAY10thFEBRUARY2012.

FAMILYNAME:_________________________

STUDENTNAME

DATEOFBIRTH

CLASS

________________________

____________

_____

________________________

____________

_____

________________________

____________

_____

________________________

____________

_____

Address:..

HomePhoneNo:..

MothersName:..WorkNo: Mobile:.

FathersName:WorkNo:.. Mobile:.

OtherEmergencyContactName:.. Number:..

(OTHERTHANPARENT)

DoctorsName:. Number:..

Medicalproblemsofwhichtheschoolshouldbeaware:

CONSENTTOPUBLISH

Pleasecompletethissectionandclearlyindicatewhetherconsentisgiven.Thankyou

IherebyCONSENTformychild/childrensname(whoarelistedabove)andphotographtobepublishedin
the Helensburgh Highlights and other school publications including School Website, Blog, Internet, Annual
SchoolReportandSchoolMagazine.

Note:PleasebeawarethatsurnameswillnotbepublishedontheInternetandnamesareneverpublished
withanaccompanyingphoto.
Forexample:Unlessconsentisgivenyourchildsnamewillnotbepublishedinourschoolnewsletter.

Signed:_____________________________

Date:________________

(Parent/Guardian)

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