Year 6 Camp Iona 2020, Nov 24-27

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Please complete the consent and health and medical profile form for your Year 6 child.

Email *

Parent name completing the form *

Child's name *

Class *

Room 1 Beth Downie

Room 1A Anya Matravers

Room 2 Megan Day

Room 2A Mark Pickering

I give permission for my child to attend Year 6 Kaikorai Outdoor Education Camp at Camp Iona. Departing Tuesday 24th November and returning on Friday 27th November *

Yes

I agree that if my child's behaviour is unacceptable, they will be removed from camp and I will be asked to collect them from Camp Iona or they will be returned by a staff member *

Yes

Medical information - please indicate in your child has any of the following *

Asthma

Epilepsy

Allergies

Bronchitis

Haemophilia

Migraine

None of the above

Other, please explain below

Required

Please outline any medication or treatment that is required by your child and when it is to be administered (include times and dosage). Or other relevant medical information. If not applicable, please state N/A *

Please indicate if any of these apply to your child *

Bedwetting

Sleepwalking

Travel sickness

Anxiety about being away from home

None of the above

Required

If you ticked any of the boxes above, please indicate below any relevant information that the staff needs to be aware of. If not applicable, please state N/A *

Please indicate any dietary requirements, for example - vegetarian, dairy-free, coeliac, if not applicable, please state N/A *

Is there anything else you would like us to know about your child?

Parents name and contact phone numbers *

Emergency contact names and numbers - please provide two points of contact. *

A copy of your responses will be emailed to the address you provided.

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