Professional Documents
Culture Documents
Dear Parent/Carer,
Miss C. Lawler
Head of Geography, Deputy Head of Curriculum
Dates of visit:
From: 16/05/2016
Teacher in charge:
Miss C Lawler
to:
18/05/2016
___________________________________________________________________________
Home Address:
____________________________________________________________________
____________________________________________________________________
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Hereby give permission for my son/daughter/ward to participate in the visit detailed above, between the dates
shown, or between any other such dates (including an extension of time) as may be substituted heretofore;
Note that neither the Council nor the teacher named above is liable for any claim or claims of whatsoever
nature arising during the visit referred to above by virtue of the attendance of my son/ward except incidents
arising from the negligence of the Council or its servants;
Warrant that the information given overleaf is correct to the best of my knowledge;
Agree that the teacher named above (or any other teacher who may from time to time be in charge of the
visit) may act on my behalf in all matters affecting or concerning my son/daughter/ward, including medical
attention. I understand that all reasonable efforts will be made to contact me before taking any action but that
in particular cases this may not be possible;
Agree to the Council making any further enquiries that it considers necessary to establish whether my
daughter/son is medically fit to participate in the visit referred to above in the light of any information given
overleaf. In the event of the Council deciding, in its absolute discretion, that he is not medically fit to participate,
I understand that any sum paid by me in respect of any costs of expenses of the journey will be refunded to
me in full (less a deduction covering administrative expenses and deposit).
MEDICATION
If your son/ward requires any medication during the journey, it is your responsibility to provide drugs in a suitable
container, clearly labelled with: his name, the name of the drug, the dosage, and the frequency to be given. An
adequate supply must be provided, to cover the whole trip, if necessary. Please give the name, address and telephone
number of his General Practitioner (GP):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Telephone Number: _____________________________________________________________________________
Please give your son/wards Medical Number (as shown on the Medical Record Card).
_____________________________________________________________________________________________
TETANUS
Has your son/ward had an anti-tetanus injection within the past ten years?
YES / NO
INFECTIOUS DISEASES
To the best of your knowledge, has he been in contact with anyone suffering from
an infectious disease during the past three weeks, or has there been any infectious
disease in the house during that time?
YES / NO
ALLERGIES
Please give below a list of substances, including drugs, foodstuff and other substances to which your
son/daughter/ward has suffered an allergic reaction at any time. If he suffers from hayfever, please state Hayfever
below.
_____________________________________________________________________________________________
ASTHMA
Does your daughter/son suffer from asthma?
If yes:
YES / NO
YES / NO
YES / NO
PHOBIA
Does your son/daughter/ward suffer from any phobia (e.g. heights)?
YES / NO
TRAVEL
Does your son/daughter/ward suffer from travel sickness?
YES / NO
SWIMMING
Can your son/daughter/ward swim 25 metres?
YES / NO
DIETARY REQUIREMENTS
Does your son/daughter/ward have any dietary needs?
YES / NO
Date: ________________