Permission to Use Trampoline

Permission to Use Trampoline

Dear Parent/Caregiver,

PERMISSION TO USE TRAMPOLINE

MonashSpecialDevelopmentalSchoolnow has a large, lockable trampoline with netted sides (“Springfree”). This trampoline will provide students with additional opportunities for physical development and be an appropriate leisure activity.

The trampoline will be used by the students according to the safety guidelines (see attached) and they will be supervised by a staff member at all times.

We are concerned that when your child uses the trampoline there may be a risk of injury because of their disability/medical condition. The types of conditions that we are concerned about include, but are not limited to, atlanto-axial instability (i.e. unstable neck joints that is sometimes present in children with Down syndrome), spinal abnormalities/fusion, Perthes disease, DDH (Developmental Dysplasia of the Hips), arthritis etc.

For children specifically with Down Syndrome, there is evidence from medical research that up to 10% of individuals with this condition suffer from a malalignment of the cervical vertebrae C1 and C2 in the neck. This condition exposes Down Syndrome individuals to the possibility of injury if they participate in activities that hyperextend or radically flex the neck or upper spine. At this school this would include jumping on the trampoline. We have received a recommendation from Special Olympics Victoria that people with Down Syndrome should have clearance from their doctor before participating in this activity. This involves an examination and possibly x-ray views of full extension and flexion of the neck.

If your child has any of these conditions, he/she will not be allowed to use the trampolines at school until the Medical Permission form has been signed and returned to school, together with the parent permission form.

If your child has a medical condition that you think might get worse if they were to use the trampoline, you should discuss this with the child’s doctor/Paediatrician and return the signed medical form to us as well as the parent form.

Otherwise, we need ALL students to have a signed Parent Permission form before they can use the trampoline. Please complete the attached form and return it to the office as soon as possible.

Yours sincerely,

Lois Mitchell

Assistant Principal

PLEASE TURN OVER
Please complete the Parent/Guardian Permission form and if appropriate the Medical Permission form and return to the School Office

Parent/Guardian Trampoline Permission Form - 2015

I ………………………………. (Parent/guardian name), give permission for my child

…...... (Student’s name) to use the Springform

trampoline at Monash Special Developmental School.

Signature of Parent/Guardian ………………………………………. Date: ………………..

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Medical Permission Trampoline Form– 2015

This section only to be completed in certain Medical circumstances, (refer overleaf)

I, ………………………………….. (Doctor’s name), deem that over and above the normal risks of jumping on a trampoline, it seems reasonable in my opinion for ……………………………………………………. (Student’s name), to be an active participant in trampoline activities.

Signed: …………………………………………………. Date: …………………

Name (Print):…………………………………………….

Address ………………………………………………….

Contact Details:………………………………………….

Provider number:……………………………………….

Helen McCoy, Principal

Email: Website:

User Drive/PPS/Proforma & Forms/New Enrolment Pack