*
Required
Visiting student's first name
*
required
Visiting student's last name
*
required
Host student's first name
*
required
Host student's last name
*
required
Host Student's Grade level
*
required
Please Select…
Grade 5
Grade 6
Grade 7
Grade 8
Date of proposed visit
*
required
(dd/mm/yyyy)
Emergency contact number
*
required
Name of contact
*
required
Secondary emergency contact number
Name of contact
Does the visiting student have any medical conditions, allergies or special needs we should be aware of?*
No
Yes
Medical Conditions
Please list any medical conditions, allergies or special needs.
Does the visiting student require any daily medication?*
No
Yes
Medication
Please list all medications required daily. We ask that all medications for Asthma are carried personally by your child. All other medications should be clearly labeled and taken to the Divisional Office by an adult on the day of the visit.
Further Information
Please provide any further information you feel may be relevant.
Please send a confirmation email to the address below: