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Yr 9 Camp Consent Form

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Please select the trip that your son will be attending:*

Student Contact Details and Medical Information

Home Address

Please enter the details of the main contact (for the duration of the visit/trip)

 NameMobile numberOther contact number
 NameMobile numberOther contact number
 Name of doctorTelephone numberSurgery address
Please tick the box below if your child does NOT suffer from any medical condition requiring regular treatment or medication.
 Name of medicationDose takenFrequency
Medicine 1
Medicine 2
Medicine 3
Does your son take over the counter medication for any reason?*
 Medicine nameDose takenfrequency
Medicine 1
Medicine 2
Medicine 3
Does your child have any allergies that staff may need to be aware of?*
 Type of reactionTreatment / medication required
Would you like to discuss your child's medical conditions or allergies with the teacher in charge?*
Does your child have an up to date tetanus immunisation?*
Are you willing for your child to be given 'over the counter' medication by staff e.g. paracetemol, throat lozenges, plasters, insect bit antihistamine?*

Any medication required should be given to the teacher in charge, clearly marked (in its prescription container if possible) with name and full instruction for use.

Inhalers and 'Epipens' may be kept by the pupil with spares given to the teacher in charge.

Does your child have any specific dietary requirements? e.g vegetarian, hala, kosher etc.*

Declaration by Parent/Guardian

1. I have read and completed this form and to the best of my knowledge the details given are true and accurate.

2. I agree to my child receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.

3. I will inform the teacher in charge as soon as possible of any changes in the medical or other details between now and the commencement of the visit/trip.

I give consent to my child attending the trip.*

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