School Trip Consent – Lytchett Minster School

Personal details

Student's name

Year

House

Parent/Carer's name

Trip details

Trip name/destination

Date of trip (or date trip commences)

Tick if trip lasts more than one day

Does this trip involve travel outside of the UK?

Yes No

Emergency details

Does your child have any health or allergy problems that might affect them on this trip?

Yes No

Does your child have any special dietary requirements (including food allergies)?

Yes No

It is important that staff know about any illnesses or conditions which your child may have and which may affect his/her participation. If necessary, and only after discussion with the trip leader, please supply the trip leader with any medication your child may need whilst away, together with written instructions. Any medical information provided will be treated in confidence.

Please advise the school if your child has been in contact with any contagious or infectious diseases or suffered from anything in the four weeks prior to departure that may be contagious or infectious. Please advise the school as soon as possible of any changes in medical or other circumstances between now and the start of the journey.

When did your child last receive a tetanus injection (if known)?

Doctor's name

Student's date of birth

Doctor's telephone number

NHS number (if known)

Home address

Home telephone number

Emergency contact number

Arrangements for going home if the visit ends outside of the school day

I will collect my child

I agree to let my child return home alone

I agree for my child to be collected by:

Consent

Staff bear a heavy responsibility when leading trips and can only be reasonably expected to do so if all participants maintain a high standard of behaviour. The school trip rules apply to every trip.

By submitting the form, you are agreeing to the following:

I have read details of the above trip and I agree to my child taking part in the trip and the activities involved.
I agree to my child receiving emergency medical treatment if necesary. I understand that the trip leaders will do their best to contact me prior to any such treatment.
I agree to my child travelling by any form of public transport and/or in an approved motor vehicle driven by a suitably-qualified and approved member of the party.
I understand that arrangements for care, supervision and discipline will be in accordance with the normal policies and practices of the school. I agree to reinforce the need for my child to follow the school's code of behaviour and understand that significant sanctions will be imposed for failure to comply with trip rules.
I accept that neither the school, Dorset Council, nor their representatives, can be held liable for any loss of personal effects or money.
I accept that I will collect/arrange the repatriation of my son/daughter at my own expense within 24 hours if he/she is implicated in any incident that contravenes the school trip rules.
My son/daughter and I understand and agree to abide by the school trip rules.

Signed (student)

Signed (parent/carer)

Parent's email address

Date