Microsoft word - parental consent forms website.doc

“Promoting Achievement and Success.”
Email: [email protected] Website: www.gusford.suffolk.sch.uk Headteacher: Mr C Tapscott B.A. (Hons) Year 6 Residential Trip to Hilltop Outdoor Centre
30th September – 4th October 2013
Parental Consent Forms
Dear Parents,
With the end of the summer term quickly approaching it is time to start preparing for the Year 6 trip
to Hilltop in October. On Tuesday 9th July I shall be holding a meeting from 6-7pm regarding this
trip, hopefully I will have received the finalised room allocation from Hilltop so both you and the
children know their groups and roommates.
Attached to this letter are three forms.
1) Parental Consent Form PC/07) must be completed for every child attending the trip.
2) Prescription Medicine Form to be filled out if your child takes regular medication (e.g.
3) Emergency Medication Form is to be completed if your child takes preventative medicine

It is really important that the forms are filled out accurately and clearly. In previous years Mrs. Pipe
and Mrs. Kitcher have spent a great deal of time checking over returned forms before seeking to
find out the missing information. Please can you make sure that on the forms the dosage of any
medication is clearly described, and also the National Health number and the date of the last
tetanus injection are accurate.
Please include any additional information, including any sleep-walking/talking habits (so we are
prepared!), in section 2 of the Parental Consent Form and feel free to approach myself, Mrs. Pipe
or Mrs. Kitcher if you have any queries or concerns.
As this information will need to be collaborated before we break up I’d really appreciate it if the
completed forms could be returned to me by Friday 5th July 2013.
Thank you for your assistance, and I look forward to meeting you on the 9th July.
Yours sincerely,
Jonathan Gray
Residential Trip Leader
Sheldrake Drive Ipswich IP2 9LQ. Tel: (01473) 682148 Fax: (01473) 692142 Email: [email protected] SUFFOLK COUNTY COUNCIL - EDUCATIONAL VISITS
PARENTAL CONSENT FORM (PC/07)
NAME OF CHILD:
DATE OF BIRTH:

SCHOOL: Gusford Primary School
VISIT(S) TO: Y6 Residential Trip – Hilltop Outdoor Centre
DATE(S) OF VISIT(S): 30th September – 4th October 2013
CONSENT
I have received and read details of the above visit(s).
I consent to my child taking part in the visit(s) and the activities indicated. I acknowledge that the staff will be liable in
the event of any accident only if they have failed to take reasonable care of my child during the visit.
I have read any information provided with regard to the standard of behaviour and/or code of conduct expected during
the visit and I undertake to reinforce this information with my child.
I consent to my child receiving medical treatment that, in the opinion of a qualified medical practitioner, may be
necessary.
My child's doctor’s name and address is:

I undertake to pay the required sums by whatever date(s) are specified to me and accept that, in respect of any withdrawal from the visit
for whatever reasons, there will be no refund of the whole or part of the payment(s) made unless the circumstances are covered by
travel insurance or otherwise at the discretion of the school governors.
I also understand that in the event of a child persistently not following the rules of the holiday or a serious act of misconduct I may
be asked as a parent to collect my child from the school residential at my expense.
Signed:
CONTACT DETAILS
PLEASE COMPLETE THE SECTIONS BELOW
1.
Please give your home address and contact phone numbers. If you will be away from home during the visit please give an alternative address where you, or a relative or friend acting for you, can be contacted. Home Address
Alternative Contact if required

Address:
Address:

Post Code:
Post Code:
PLEASE COMPLETE MEDICAL DETAILS OVERLEAF MEDICAL DETAILS
In your child's interest, it is important that the organising staff should know whether he or she suffers from any illness or medical condition. Please use this space to state, in confidence, any health or other matter concerning your child of which accompanying staff should be aware. Please indicate here also if your child is receiving medication
Any medical conditions/disabilities: (e.g. epilepsy, asthma etc.)
Any medication currently being used (e.g. Ventolin inhaler etc.) Do you give consent for a member of staff to administer medicines such as Calpol, piriton/anti-allergy cream/medicine, stomach upset medicine, suncream etc. as is necessary. Please note if your child has the need for medication on the school journey you will need to complete a) Prescription medication form (for regular medication eg preventative inhaler every morning
b) Emergency medication form (for emergencies eg emergency inhaler, diabetic medication, epipen)
Sheldrake Drive Ipswich IP2 9LQ. Tel: (01473) 682148 Fax: (01473) 692142 Email: [email protected] A) Prescription Medication Form
Request for the school to administer prescription medication
The school will not give your child medicine unless you complete and sign this form, and the headteacher has agreed that school
staff can administer the medication. Please read and sign the disclaimer printed overleaf
DETAILS OF PUPIL
Condition or illness: …………………
……………………………………………
MEDICATION
Full Directions for use:

CONTACT DETAILS:
Address: .……………………………………………… My child’s doctor has prescribed the above medication. I understand that I must deliver the medication personally to an agreed member of staff. I accept that this is a service which the school is not obliged to undertake. LEGAL DISCLAIMER I understand that neither the Headteacher nor anyone acting on his/her authority, nor the Governing Body, nor Suffolk County Council will be liable for any illness or injury to the child arising from the administering of the medication or drug unless caused by the negligence of the Headteacher, the person acting on his/her authority, the Governing Body, or Suffolk County Council, as the case may be. Signature: Sheldrake Drive Ipswich IP2 9LQ. Tel: (01473) 682148 Fax: (01473) 692142 Email: [email protected] B) Emergency Medication Form
Parental Consent and Indemnity Form For Administering Prescription Medicines in an Emergency

DETAILS OF PUPIL
Condition or illness: .

MEDICATION
Full Directions for use:

CONTACT DETAILS:
I, the parent/guardian of the above named child, request and give permission for the Headteacher, or person acting on his/her authority, to administer the above medication in emergency circumstances and in accordance with the directions given. I understand that neither the Headteacher nor anyone acting on his/her authority, nor the Governing Body nor Suffolk County Council will be liable for any illness or injury to the child arising from the administering of the medicine or drug unless caused by the negligence of the Headteacher, the person acting on his/her authority, the Governing Body or Suffolk County Council, as the case may be. Signature:

Source: http://www.gusford.suffolk.sch.uk/Hilltop2013Parentalconsentforms.pdf