Home Address *

Parent / Guardian Contact Number *

Parent / Guardian Contact Email *

Emergency Contact Name #1 *

Emergency Contact Number #1 *

Emergency Contact Work Number #1 *

Emergency Contact Name #2 *

Emergency Contact Number #2 *

Emergency Contact Work Number #2 *

Agreements *

My son / daughter has no ailment or medical condition that the teacher leading the visit should be aware of, or that would be aggravated by the activities described in the information sheet/letter. *

My son / daughter has an ailment or medical condition that could be aggravated by the activities described in the information sheet / letter. Please give details (eg; sleepwalking, travel sickness, hayfever, asthma etc) *

Your comment

My son/daughter IS / IS NOT (Select below) taking any medication. *

IS
IS NOT

If your son / daughter is taking medication please give details (type/name, dosage, times, method of administration.  

Medication Comments

Please specify if your son / daughter has any allergies, food intolerances or special dietary requirements: *

When did your son / daughter last receive a tetanus injection? *

Name, Address and Telephone number of the family doctor *

Select yes if you are happy for us to seek emergency contact as a first contact in the instance of a critical incident *

Child Protection Policy *

Code and Conduct Policy *

Health & Safety *

Payment Policy *

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