21.05.2019 - Year 2. Summer Camp Confidential Consent Form
Year 2 Camp 2019
PARENTAL CONSENT FORM
1. DETAILS OF VISIT
Visit to: Round Hill School Camp
Date(s)/Times: From 5.30pm 11th July– 3.30pm on 12th 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. __________________________________________________________________________________________________________________________________________________________
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: ___________________________
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 11th July 2019. I will be able to volunteer from 10.00pm-02.00am /
02.00am-06.00am (delete as appropriate).
Date ___________________________ Signed _____________________________
* Please send to school as soon as possible