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Thorpe Park PARENTAL / GUARDIAN
CONSENT, CONTACT AND MEDICAL FORM


This form moldiness be completed and returned to the teacher in charge of the trim or trip,
before any savant can be allowed to participate.
Parental Consent
First nameFamily name:
Date of behaveForm:

Trip toThorpe Park
Date of trip

I represent to my son/daughter taking part in the in a higher place mentioned Trip Parent or protectors signature


Student Contact Details
hearthstone address


Contact telephone number (for the duration of the trip)
boot property
MobileWork

Alternative contact Relationship to student :
Address


beHome
MobileWork

Medical Information
Name of doctorTel no
Address
of surgery

Please mark with X if capture :
My pincer does not suffer from any medical originator requiring regular treatment.

My child suffers from
and has been prescribed
the following medicationName of medicationDoseFrequency




?

My child has an allergy
to the following:
Allergic to geek of reaction



Please delete as appropriate
I would like to hold forth my childs medical condition with the teacher in charge.YES NO
My child has an up to date tetanus injection.YES NO
I am willing for my child to be given with over-the-counter medication by round e.g. paracetamol, throat lozenges, plasters, insect bite antihistamine.



YES NO

Any medication needed should be given to the teacher in charge, clearly tag (in its prescription container if applicable) with name and full instructions for use.

Inhalers and Epipens may be kept by the pupil with spares given to the teacher in charge.

Dietary Information

Does your child have any special dietetic requirements
e.g. vegetarian, kosher, allergies (please give details)YES NO


Additional Information

Please include any spare information as required


Declaration by Parent/Guardian


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