Trip Information

I give permission for my child to take part in the Year 7 Kingswood Residential Trip on Wednesday 11th October- Friday 13th Ocitober
*

Student information

Student's full name *
Form *
Date of birth *
Full name of parent/guardian *

Emergency details

Contact 1

Contact name *
Relationship to student *
Home telephone number *
Mobile telephone number *

Contact 2

Alternative contact name *
Relationship to student *
Alternative contact telephone number *

Student Medical Information

Does your child suffer from any existing condition requiring medical treatment, including medication? *
If YES, please provide full details including Emergency Procedures. Please ensure that the Group Leader is given adequate supplies of all emergency medication (N.B. prescribed medication only)
Is your child allergic to any medication, insect bites or food? *
If YES, please provide full details including Emergency Procedures.
I give permission for over the counter medication (such as paracetamol/Calpol and ibuprofen) be administered by the group leader if required

* A phone call to the parent/guardian will be made prior to any medication being given to confirm consent and the amount given *


Dietary Requirements

Please indicate if your child has any specific dietary requirements

Consent

I agree to my daughter / son / or child in my care taking part in any school journey. I acknowledge the need for good conduct and responsible behavior on their part.

Signed *
Dated *


Please leave the next box blank or your submission will not be accepted: