Parental Consent for a School Visit\Residential

Idsall School Policy for Educational Visits and Journeys

Select one of the trips that your child is going on:*Child's Full Name:* Date of Birth:* Next of Kin:*

Next of Kin Contact Numbers:

Mobile* Work Home* Email address:* Home Address:*

Alternative Emergency Contact Details:

Name:* Telephone Number* Address:* I agree to: Name of Child:*

taking part in this visit and have read the information sheet. I agree to their participation in the activities described. I acknowledge the need for them to behave responsibly.

2. Medical Information about your child:

GPs / Consultants name:* Telephone number:* Address:* a. Does your child have any pre-existing/ or current medical condition or disabilities?* If YES, please give brief details: b. Is your child currently taking any medication?* if YES, please give brief details: c. Is your child currently receiving medical treatment?* If YES, please give brief details:

PLEASE NOTE: ALL MEDICINES SHOULD BE HANDED TO A TEACHER ON THE DAY OF DEPARTURE. UNDER NO CIRCUMSTANCES SHOULD CHILDREN HAVE MEDICINES IN THEIR POSSESSION. ONLY MEDICINES PRESECRIBED BY A DOCTOR WILL BE ADMINISTERED. PLEASE DO NOT SEND ADULT DOSES OF PAIN RELIEF PACKED IN CHILDRENS BAGS.

d. What type of pain relief medication may your child be given if necessary?* e. Is your child allergic to anything?* f. Please outline any special dietary or other requirements of your child: g. Date of last anti-tetanus injection, if unknown please fill in unknown.* h. To the best of your knowledge, has your child been in contact with any contagious diseases or suffered from anything in the last four weeks that may be contagious or infectious?* If YES, please give brief details:

I will inform the Party Leader/Headteacher as soon as possible of any changes in my child's medical or other circumstances between now and the commencement of the journey.

Child's shoe size (for Edge-ucation Climbing Trip ) I agree to photographs taken during the visit being used in documents such as the prospectus and the school website.*

For trips that include swimming:
Is your child:

Able to swim?* Able to swim 50m?* Water confident in a swimming pool?* Confident in the sea or open water?* Safety conscious in water?*

3. Declaration

I agree to my child receiving medication as I have instructed. I authorise the leaders and the first aiders on this visit to give permission for my child to receive any emergency:

Dental Treatment* Medical Treatment*

Surgical treatment (including the administration of anaesthetic as considered necessary by the medical authorities present, if this should occur at a time when my consent to a particular treatment cannot otherwise reasonably be obtained).

Blood Transfusions* Resuscitation*

Note: If there are some medical treatments you will not consent to please ensure that you inform the trip leader by attaching details to this form.

I understand the extent and limitations of the insurance cover provided. Signed:* Date* Full name (capitals):* Password*

Parental Consent for a School Visit\Residential

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