Parental_Consent_Form_AB
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© Doncaster June 2004 Section 10 – Forms School: Hatfield Woodhouse Primary School Details of visit to: Date - From: To: Time: 1. I acknowledged the need for ________________________________ (name) to behave responsibly. 2. Medical information about your child (a) Any conditions requiring medical treatment, including medication? Yes / No If YES, please give brief details: _________________________________________________ ____________________________________________________________________________ (b) Please outline any special dietary requirements of your child and the type of pain / flu relief medication your child may be given if necessary: ____________________________________ ____________________________________________________________________________ (c) Is your son/daughter allergic to any medication? Yes / No If Yes, please give brief details: ______________________________________ ____________________________________________________________________________ (d) When did you son/daughter last have a tetanus injection? _____________________________ Name of family Doctor: ___________________________ Telephone number: _________________ Address: ________________________________________________________________________ 3. Declaration I would like _________________________________ (name) to take part in the specified visit and having read the information provided agree to him/her taking part in the activities described. I agree to my son/daughter 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. I will inform the Group Leader / Headteacher as soon as possible for any changes in the medical or other circumstances between now and the commencement of the journey. Contact telephone numbers: Work: ______________________ Home: ______________________ Home address: ____________________________________________________________________ Alternative emergency contact: Name: _______________________________________ Telephone number: _________________ Address: ________________________________________________________________________ Signed: __________________________________________ Date: ____________________________ Full name (capitals): ____________________________________________________________________ PARENTAL CONSENT FORM CATEGORY A or B SCHOOL VISIT
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3. Declaration I would like _________________________________ (name) to take part in the specified visit and having read the information provided agree to him/her taking part in the activities described. 2. Medical information about your child (a) Any conditions requiring medical treatment, including medication? Yes / No If YES, please give brief details: _________________________________________________ ____________________________________________________________________________ © Doncaster
Transcript of Parental_Consent_Form_AB
© Doncaster June 2004 Section 10 – Forms
School: Hatfield Woodhouse Primary School Details of visit to:
Date - From: To: Time:
1. I acknowledged the need for ________________________________ (name) to behave responsibly.
2. Medical information about your child (a) Any conditions requiring medical treatment, including medication? Yes / No If YES, please give brief details: _________________________________________________
____________________________________________________________________________
(b) Please outline any special dietary requirements of your child and the type of pain / flu relief
medication your child may be given if necessary: ____________________________________
____________________________________________________________________________
(c) Is your son/daughter allergic to any medication? Yes / No
If Yes, please give brief details: ______________________________________
____________________________________________________________________________
(d) When did you son/daughter last have a tetanus injection? _____________________________
Name of family Doctor: ___________________________ Telephone number: _________________
Address: ________________________________________________________________________ 3. Declaration
I would like _________________________________ (name) to take part in the specified visit and having read the information provided agree to him/her taking part in the activities described.
I agree to my son/daughter 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.
I will inform the Group Leader / Headteacher as soon as possible for any changes in the medical or
other circumstances between now and the commencement of the journey.
Contact telephone numbers: Work: ______________________ Home: ______________________
Home address: ____________________________________________________________________
Alternative emergency contact:
Name: _______________________________________ Telephone number: _________________
Address: ________________________________________________________________________
Signed: __________________________________________ Date: ____________________________
Full name (capitals): ____________________________________________________________________
PARENTAL CONSENT FORM CATEGORY A or B SCHOOL VISIT
