Lower School Camp Consent Form

Name of Child *

First

Last

Year *

Class *

Medical Practice *

Medical Practice Address *

Address Line 1

Address Line 2

City

County

Post Code

Medical Practice Phone *

Medical Conditions (if any including travel sickness)

Do you give permission for your child to be given over the counter medicine? *

Yes
No

E.g. paracetemol, ibruprofen,

Dietary Requirements (Please state any additional requirements or exclusions from diet)

Are any of the following required?

Inhaler
Epi-Pen

Has your child had a tetanus injection? *

Yes
No

Date

Can your child swim? *

Yes to 10 metres
Yes to 25 metres
Yes to 50 metres plus
No

If there any further information that may be useful, please state it here

CAMP PARTICIPATION CONSENT

I agree to my child participating in camp and understand the nature of the activities involved. In the event that neither I, as parent/guardian, nor my 1st emergency contact can be reached in an emergency when my child is at camp, I agree to medical/dental treatment being given to my child. This may include, medical or surgical treatment, including anaesthetic or blood transfusions as considered necessary by the medical authorities present.

Name and Relationship to Child *

Email *

Signature *

Clear Signature

Date *

CAMP PARTICIPATION CONSENT

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