reply slip, together with the Parental Consent Form - Sir William ...

Reply Slip – Please return to Reception by Monday, 24 th June 2013.
Year 12 Brighton Trip - Thursday 18 th July 2013
Student Name: …………………………………
Form: ………….
I give permission for my son/daughter to attend the above event.
I enclose a signed and completed Parental Consent Form.
I confirm that my son/daughter will conform to the school’s code of conduct
before and during this trip and that I will be accountable should he/she breach
these regulations.
I understand that any monies paid will not be refunded if my son/daughter is
excluded from attending this trip due to behavioural issues.
I will make arrangements for my son/daughter to travel home safely on our
return.
I will provide my son/daughter with either a disposable packed lunch and soft
drink or money for lunch / refreshments.
My son/daughter receives free school meals and will require a school packed
lunch.
Signed: …………………………………………
Date: ……........

PARENTAL CONSENT FOR A SCHOOL VISIT
School/Group: Sir William Ramsay School, Rose Avenue, Hazlemere, Bucks, HP15 7UB
Pupil’s name: …………………………………..
Date of birth ……………………..
Visit to: Brighton Beach, Pier, Town Centre
From: Thursday 18th July 2013, 9.00 am To: Thursday 18th July 2013 7.00 pm
1. I agree to ………………………… (name) taking part in this visit and have read
the information sheet. I agree to ………………………’s participation in the
activities described. I acknowledge the need for …………..………... to behave
responsibly.
a. I confirm that my son/daughter is a confident, competent swimmer.
2.
a.
b.
Medical information about your child
Any conditions requiring medical treatment, including medication? YES/NO
If YES, please give brief details:
……………………………………………………………………………………………..
……………………………………………………………………………………………..
……………………………………………………………………………………………..
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. To the best of your knowledge, has your son/daughter been in contact with any
contagious or infectious diseases or suffered from anything in the last four weeks
that may be contagious or infectious?
YES/NO
……………………………………………………………………………………………..
……………………………………………………………………………………………..
d. Is your son/daughter allergic to any medication? YES/NO
If YES, please specify
……………………………………………………………………………………………..
……………………………………………………………………………………………..
e. When was the last time your child received a tetanus injection?
………………………………………………………………………………………
f. Does your son/daughter suffer from motion sickness? YES/NO

Declaration
I agree to my son/daughter receiving medication as instructed and any urgent dental,
medical or surgical treatment, including anaesthetic or blood transfusion, as considered
necessary by the medical authorities present. I understand the extent and limitations of
the insurance cover provided.
I will inform the Group Leader/Head Teacher as soon as possible of any changes in the
medical or other circumstances between now and the commencement of the journey.
Signed: …….……………………………………………. Date: ……………………………
Full name (capitals): …….……………………………………………………………………
Contact telephone numbers:
I may be contacted by telephoning the following numbers:
Work: ………..…….……………………………… Home:…..…..……………………….
Home address: ……..……..……………………………………………………………………
..……………………………………………………………………………………………………
E-mail: ………………..………………………………………………………………………….
If I am not available at above, please contact:
Name:…………………………………….………. Tel No:…..…………………………..
Address: ……………………….…………………………………………………………………
…………..…………………………………………………………………………………………
Name and address of family doctor:
Name: …………………………………………………. Tel No: ……………………………..
Address: ………………………………………………………………………………………….
…………………………………….………………………………………………………………..
THIS FORM OR A COPY MUST BE TAKEN BY THE GROUP LEADER ON THE
VISIT. A COPY SHOULD BE RETAINED BY THE SCHOOL CONTACT