30 November 2017

Dear Parent/Guardian,

Please find below a comprehensive list of all Rockhampton District Secondary Schools Trials for 13-19 years for 2018. It is important to note that each individual trial that each student participates in incurs a cost of $5.00, to be paid at the Cash Collection Window at school (paper nominations exempt from payment). For example, Student A trials for Rugby League, Touch Football and Volleyball, $15.00 is payable to school to cover trial costs.

It is important to know that students who are intending on representing Rockhampton State High School at RDSSS trials must be on the appropriate behavior level. The Principal reserves to right to preclude students from trialing at their discretion.

Please indicate your student’s intention to trial for each/ any of the following sports on the form below and return it with the correct amount of money AND the attached RDSSS Medical Form to the Cash Collection Window – a minimum of 1 week prior to the trial date.

Please note that if a student pays to trial and has can not attend for some reason, the allocated money will be automatically transferred to that student’s school account to cover text hire fees.



(Please tear off and return to the cash collection window with payment)

Student name: ______Form class: ______

Term / Date & Event / District Trials Venue / Intention to trial (tick )
1 / Tuesday 30 January
Cricket 16 - 19 Boys / 9:30am – 11:30am
Rockhampton Grammar School top oval
Monday 29 January
Tennis 13-19 years / 9am – 3pm
Rockhampton Tennis Centre
Water Polo 13-17 years / Trials held in 2017
Softball 13-19 years / Paper nomination
Swimming / Nomination to CSS
Thursday 8 February
Volleyball 12 – 15 / 16- 19 B & G / 11am – 12:30
Rockhampton State High School
Friday 2 February
Rugby Union 17-18 years / 9:30am – 11:30am
Rugby Park
Wednesday 14 February
16-18 Basketball B & G / Girls: 9:30 – 10:30am
Boys: 10:30 – 11:30
Heights College
Wednesday 7 February (Boys)
Rugby League 13-15 and 16-18 / 10am – 1pm
St Brendans College
Thursday 8 February
13-15 Boys & 13 – 16 Girls AFL / 9am – 11am
Rockhampton State High School
Thursday 15 February
Touch Football
Boys & Girls 13-15 and 16-18 / 9am – 12pm
Rockhampton Touch fields
Sunday 4 February 2pm – 5pm
Girls Netball 13-15 years / Emmaus College Yaamba Rd (dome)
If shortlisted, girls will be invited to 2nd trial:
Wednesday 7 February 9am – 11:30
Emmaus College hall
Wednesday 7 February
Girls Netball 16-19 Years / 12pm – 2pm
Emmaus College Hall
Wednesday 21 February
Hockey B and G 13-19 / 9am – 11am
Kalka Shades
Wednesday 21 February
Football B and G
16-19 years / 9am – 11am
Capricorn Coast Soccer fields
Wednesday 28 February
Squash Boys and Girls
10-15 / 16-19 / 12pm – 3pm
Scotvale Squash courts
Cross Country 10-19 years / Tuesday 1 May
2 / Thurs 26 April
Football B & G 13-15 years / 9am – 11am
Capricorn Coast Soccer fields
Monday 30 April
Rugby Union 14-15 years / 9:30am – 11:30am
Rugby Park
Tuesday 8 May
Girls Rugby League 14-15 years &16-18 years / 9am – 11am
Glenmore State High oval
Monday 30 April
Basketball B & G 13 -15 years / Girls: 9:30 – 10:30
Boys: 10:30 – 11:30
Heights College
Athletics
10-19 years / Monday 30 and Tuesday 31 July
North Rockhampton High School
3 / Tuesday 7 Aug
Cricket 13-14 B and 13-15 G / 1pm – 3pm
RGS

“I acknowledge that the Department of Education, Training and the Arts does not have Personal Accident Insurance cover for students”.

I have read the above information and understand that my son/daughter must comply. I give my permission for ______Class ______to attend the excursion. I authorize the teachers to obtain medical assistance which they deem necessary should an accident occur, and agree to pay all medical expenses on behalf of the above student. At times students may be transported in teacher’s vehicles or the school bus with a licensed driver. I have enclosed $______payment to cover the trial costs.

Date Parent/Guardian Signature

Parental Permission/Student Medical Information

Students Name:______School:______Date of Birth: ____/ ____/ ____Male / Female

Sport Trial Attending: ______Date of Trial: ______

Preferred Playing Positions (Please list 2 if possible): ______

Emergency Contact Name and Phone Number: ______

Student Medical Information I submit the following medical information about the above student and include details of limitations which she/he has for the activity concerned.

Does/has the student suffered from - / (detail current medication/management)
a.
b.
c.
d.
e.
f.
g.
h.
I.
j.
k. / Allergies
Asthma
Blood pressure
Drug reaction
Epilepsy
Heart problems
Operations
Phobias
Recent illness
Respiratory problems
Travel sickness / Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No / ______
Detail any other medical /injuries / problems which may limit participation in the activity ______
______
Immunisation Record - / Hepatitis B / Yes / No / Year ______/ Tetanus / Yes / No / Year ______
Other ______
Detail any medication(s) your daughter/son/ward is currently using ______
______
Does your daughter/son/ward have -
Medicare Card
Private Health Ins / Yes / No
Yes / No / Card No. ______
With ______
Card No. ______/ Expiry date ___/ ___/ ___
Expiry date ___/ ___/ ___
Category ______/ cardholder name ______
cardholder name ______

Playing history:

______

Principal’s Declaration

  • I certify that the student whose details appear on this form is enrolled at this school.
  • I have verified that the date of birth as stated on this form is correct.
  • He/she has the school authority to represent on this occasion.
  • A copy of this consent form will be retained by my school for the year.

SIGNED: ......

(Principal or Sports Coordinator )(Date)

Parental/Caregiver Consent

  • I have read the information issued and I hereby consent to my child participating in this event.
  • I understand that teachers will provide supervision at the event.
  • I understand that if my circumstances change, it is my responsibility to inform school.
  • I understand that transport to and from the event is my responsibility and that the arrival and departure arrangements are also responsibility of the parent/caregivers unless otherwise specified.
  • In the event of any accident or illness, I authorise the obtaining, on my behalf, an ambulance and any such medical assistance that my child may require. I accept full responsibility for all expenses incurred.

SIGNED: ......

.(Parent/Caregiver) (Date)