By continuing to complete this form you are agreeing to the statement below:
I agree to my son/daughter/ward taking part in the above stated visit/activity and having read the information sheet, agree to his/her participation in any or all of the activities described. I acknowledge the need for good conduct and responsible behaviour on his/her part and that the school reserves the right to prevent my son/daughter/ward continuing with the visit/activity in the case of poor behaviour. Further, I understand that there would be no entitlement to a refund of monies paid. I agree that I will update the school with any medical information or changes to emergency contact details.
Emergency Contact Details
Contact Name *
Your answer
Contact Address *
Your answer
Contact Telephone Number *
Your answer
Alternative Contact
Please state an alternative contact point:
Alternative Contact Name *
Your answer
Address *
Your answer
Telephone Number *
Your answer
Other Information: Please supply any additional information that you wish the Visit Leader to be aware of (e.g. medical conditions, allergies, recent illness, special requirements etc) which may affect him/her in this visit:
Your answer
Declaration by Parent/Carer (Please answer all questions)
In the case of an emergency I agree to my child being given any medical, surgical or dental treatment, including general anaesthetic and blood transfusion, as considered necessary by the medical authorities present. *
I consent to my child taking part in the visit and, having read the information sheet, I declare my child to be in good health and physically able to participate in any activities mentioned; subject to any agreed adjustments. *
I have noted where and when the children are to be returned and I understand that I am responsible for my child getting home safely from that place. *
I will ensure that any change in the circumstances (e.g. recent illness, medication or injury) which will affect my child’s participation in the visit will be notified to the School prior to the visit. *
I have read and understood the School's behaviour contract. *
Name of Parent/Carer *
Your answer
Address (if different from above)
Your answer
Verification
By clicking Submit you are confirming that all details contained within this form are correct
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