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Consent Form DETLING

This educational visit consent and medical form collects information about students' medical conditions and needs for an upcoming visit to Detling UCAS event. It requests details about allergies, illnesses, medical treatments, physical disabilities, dietary restrictions, and emergency contact information. The form also requires consent for medical examination and treatment in an emergency. Students or their parents must sign agreeing to the standards of behavior for the visit and acknowledging their responsibility for arranging travel home if standards are not met.

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miskinmusic123
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
109 views1 page

Consent Form DETLING

This educational visit consent and medical form collects information about students' medical conditions and needs for an upcoming visit to Detling UCAS event. It requests details about allergies, illnesses, medical treatments, physical disabilities, dietary restrictions, and emergency contact information. The form also requires consent for medical examination and treatment in an emergency. Students or their parents must sign agreeing to the standards of behavior for the visit and acknowledging their responsibility for arranging travel home if standards are not met.

Uploaded by

miskinmusic123
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Educational Visit Consent & Medical Form

This form is to be completed and signed by students over 18 years of age or by a parent or guardian for students

under 18 years of age and SLDD students under 25 years of age. PLEASE COMPLETE IN BLOCK CAPITALS

Visit to:
DETLING UCAS EVENT - FRIDAY 15 t h MARCH 2019
Student’s name:

Are there any activities in which you/your son/daughter/ward should not participate. If so, please give details:

Name, address and contact details of student’s doctor:

Are you/is he/she allergic to anything, e.g. medicines, food, pollen, etc? If so, please give details:

Do you/does he/she suffer from any of the following? Asthma, chest complaints, migraine, bad period pains,
travel sickness, diabetes, fits or faints? If so, please give details:

Are you/is he/she having any medical treatment at present? If so, please give details of treatments and
medicines: (Please remember that prescribed medicines may be handed in, before departure, to the staff in charge in their original,
labelled box / bottle for safe keeping.)

Do you/does your son/daughter/ward have any physical disability? Please give details of any special attention
required:

Please use this space to inform the staff in charge, in confidence, of any other medical condition or health
problem that may affect you/your son/daughter/ward during this visit: (If you would prefer to communicate confidential
information in writing to the party leader, please do so.)

Date of last anti-tetanus injection:

Please indicate any special food / dietary requirements:

! In the event of me/my son/daughter/ward not conforming to the standards of behaviour required by the
member of staff in charge of the visit, I will personally be responsible for all arrangements to get
myself/my son/daughter/ward home.

I, _________________________________________ give consent to my medical examination/the medical examination of my


son/daughter/ward when necessary whilst I am/he/she is taking part in the visit and I request that any operation or any other
measures considered necessary, by a medical authority, for my/his/her diagnosis and treatment shall be performed and I hereby give
permission for such an operation or other measures to be carried out in an emergency only and for the administration of general or
local anaesthetic if necessary.
I am willing / not willing to take part/for my son/daughter/ward to take part in the visit detailed and, having read all the
information provided, agree to taking part/him/her taking part in any of the activities mentioned except those specified.

Signed: _______________________________ Date: _______________________________

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