Trips

Parental / Carer Consent Form

Trip name:* Student name:* Tutor group:* Please state any medical history, eg. diabetic, asthma:

Note - any medication must be clearly marked with medication name, dose and frequency. It must be handed to the Group Leader prior to leaving on the visit.

Is the student allergic to any medication? If YES state: When was the student's last tetanus injection? Please state date:* State pain / common cold relief medication the student may be given if necessary: Outline any special dietary requirements of the student: Main Contact Name:* Home Address:* Contact numbers:* Emergency Contact Name:* Address:* Contact number:* Family GP Name:* GP Address:* GP Telephone Number:*

Parent / Carer Declaration

I will inform the Group / Trip Leader as soon as possible of any changes in medication, student's health condition or other circumstances not listed above before the start of the visit.

The Duston School

Trips

Parental / Carer Consent Form

Note - any medication must be clearly marked with medication name, dose and frequency. It must be handed to the Group Leader prior to leaving on the visit.

Parent / Carer Declaration

I will inform the Group / Trip Leader as soon as possible of any changes in medication, student's health condition or other circumstances not listed above before the start of the visit.

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