Residential Trip Consent Form

Please note where places are on a first come first served basis we cannot accept any applications entered before 6pm on the day the letter is issued.

TRIP NAME: (please type the trip name given on the letter) *

Name of Trip Leader (Teacher) *

Pupils Forename: *

Pupils Surname: *

Form Group: * eg. 13BM

From: *

To: *

CURRENT MEDICAL INFORMATION ABOUT YOUR CHILD:

Does your son suffer from any medical conditions or allergies?

(Please provide full details of the symptons and treatment and medication of each condition)

Please note the information provided below is specific to this trip and must include all/any medical conditions that your son has.

Condition 1

Condition 2

Condition 3

Have you included in the above any NEW medical conditions which the school have not previously been made aware of? Please tick relevant box.. If Yes, we may need to contact you to discuss this further.

Yes
No

If your son takes regular medication, please confirm which sentence best describes the administration of your son's medication.

My son will self medicate
My son will self medicate but may need support
My son will need support in taking medicines

Does your son have any dietary requirements or any food allergies. If YES, please detail below:

GP's Practice *

GP's Telephone Number

NHS No. (if known)

I undertake to inform the Trip Leader as soon as possible of any changes in the medical circumstances of my son or if he has been in contact with any contagious or infectious diseases between the submission of this form and the start of the journey.

Agree *

PLEASE NOTE: Failure to disclose sufficient information at this stage may result in your son being withdrawn from a trip in the event of any discrepancy between his medical/dietary needs and the information provided to us. If necessary the Trip Leader may contact you to discuss medical and dietary issues in greater detail and whether or not it is safe for your son to participate in the visit.

Altrincham Grammar School For Boys

A Grammar School with Academy Status
Labor Omnia Vincit

Residential Trip Consent Form

Does your son suffer from any medical conditions or allergies?

(Please provide full details of the symptons and treatment and medication of each condition)

See also: