Year 2 Camp 2019

CONFIDENTIAL

PARENTAL CONSENT FORM

 

1.      DETAILS OF VISIT

 

Visit to: Round Hill School Camp

 

Date(s)/Times: From 5.30pm 11^th July– 3.30pm on 12^th July 2019

 

I agree to my son/daughter ____________________________(NAME) taking part in the above-mentioned visit and, having read the information provided, agree to his/her participation in any or all of the activities described.  I acknowledge the need for obedience and responsible behaviour on his/her part.  I understand the extent and limitations of the insurance cover provided.

 

• If there are any activities in which your child cannot participate please give details.        ________________________________________________________________________________________________________________________________________

 

2.      MEDICAL INFORMATION

 

a) Does your son/daughter suffer from any conditions of which the teacher leading the visit should be aware: YES / NO

 

        If YES, please give brief details, including details of any medication

            __________________________________________________________________

            __________________________________________________________________            ______________________________________________(Attach sheet if necessary)

 

b) To the best of your knowledge, has your son/daughter been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be, or become, contagious or infectious?   YES / NO

 

            If YES, please give brief details

            _____________________________________________________________

 

            c) Is your son/daughter allergic to any medication?  YES / NO

 

            If YES, please specify.

            _____________________________________________________________

 

            d) Has your son/daughter received a tetanus injection in the last five years?

              YES / NO

 

e) Please outline any special dietary requirements of your child.     __________________________________________________________________________________________________________________________________________________________

 

 

 

 

 

 

 

 

MEDICAL DECLARATION

 

I undertake to inform the Phase Leader/Head as soon as possible of any change in the medical circumstances between the date signed and the commencement of the camp.

 

I agree to my son/daughter receiving emergency medical treatment, including anaesthetic, as considered necessary by the medical authorities present.

 

 

3.      CONTACT NUMBERS

 

I may be contacted by telephoning the following numbers:

 

            Work: _________________________ Home: _________________________

           

My home address is  ___________________________________________________

 

If not available at home, please contact:

 

            Name __________________________Telephone: ___________________________

 

            Address: ___________________________________________________________

           

Name, address and telephone number of family doctor:

____________________________________________________________________________________________________________________________________

           

4.      ANY OTHER RELEVANT INFORMATION

 

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

5. PARENT VOLUNTEERS (if available)

 

I ______________________________ parent of ________________________________

 

in _________________ Class, would like to volunteer to supervise the children during the    

 

Year 2 camp on Thursday 11^th July 2019. I will be able to volunteer from 10.00pm-02.00am   /   

 

02.00am-06.00am (delete as appropriate).

 

 

6.      SIGNATURE

 

            Date ___________________________ Signed _____________________________

 

* Please send to school as soon as possible