IES BLOUBERG INTERNATIONAL SCHOOL

GENERAL CONSENT FORM FOR DOMESTIC FIELD TRIPS

1. Consent. This consent is related to all domestic educational visits and other off-site activities, performed during or outside
school hours and whether or not they form part of the School´s curriculum (hereinafter “Field Trips”). By signing this consent
you agree your child taking part in the referred activities as a general consent form. Notwithstanding your consent given, the
School will provide you with information about proposed Field Trips before they take place, which will give you the
opportunity to inform the School if you do not wish your child to take part in a particular trip.

Student´s surname

Student´s first name

Date of birth Grade / Form:

Home address

Name of parent / guardian

Emergency contact telephone/s

2. Health, disability and special needs. Please provide details of your child´s medical condition(s), long term medication
requirements, dietary requirements or special needs below:

I confirm that to the best of my knowledge and belief my child is in good health. I am aware of no reason on medical grounds
why my child should not take part in Field Trips. I have provided full information on any disability or special needs that
might affect my child´s ability to take part in Field Trips or have an effect on the safety and welfare of my child or others in
the party. I agree to update the School in the event that my child´s health, disability, or needs change.

3. Accident / Illness. I consent to all emergency or other medical or dental treatment including inoculations, general or local
anaesthetic, surgery or blood transfusions which, in the opinion of a qualified medical practitioner, are necessary for the
safety and wellbeing of my child.
I accept that the School commits to ensure, so far as reasonably practicable, student´s health and safety whilst on Field Trips.
The School will conduct risk assessments to evaluate the risks of all Field Trips and will inform me of foreseeable risks
before the visit takes place.
4. Transport. I consent to my child travelling by any form of public transport and / or in motor vehicle(s) driven by the group
leader or any other supervisor who is authorised by law and duly insured to drive. I acknowledge that there are inherent risks
associated with travel to, from, and within a Field Trip and agree to brief my child in order for him/her to take every
precaution to safeguard his/her personal health and safety.
5. Personal effects of the student. I acknowledge that my child will be responsible for the safety of his/her own money and
personal effects. The School shall not be responsible for losses, unless these are caused by the negligence of the School.
6. Breach of discipline. I understand and accept that if my child is sent home early from the Field Trip because of a breach of
discipline, I will be required to meet the costs.
General Consent Form for Domestic Field Trip. 11-January-2016 Edition 1 of 2
7. Swimming and other adventure activities (please tick as appropriate). I confirm that:
 My child is able to swim 50 metres: ____
 My child is water confident in a pool:____
 My child is confident in the sea / open inland water:____
 My child is safety conscious in water:____
8. Limitation of Liability. Nothing in this form limits or excludes the School´s liability for death or personal injury caused by
the School´s negligence or the negligence of its employees, agents or subcontractors or for anything else in respect of which if
would be unlawful for the School to exclude or limit its liability.
I accept the School shall not be liable for any loss or damage resulting from situations beyond its reasonable control.
If the School fails to comply with these terms or with its Field Trips policy or acts negligently it is responsible for loss or
damage the student may suffer that is a foreseeable result. However, the School is not responsible for any loss or damage that
is not foreseeable. Loss or damage is foreseeable if it was an obvious consequence of the School´s breach or if it was
contemplated by the School and me at the time of declaration.

Parent or Guardian´s declaration

Name of Parent / Guardian Relationship to student:

Signed Date:

Name of Parent / Guardian Relationship to student:

Signed Date:

Student´s declaration (from 14 years old and over)

I promise to observe the rules governing behaviour on Field Trips and also the School Rules and/or Code of Conduct. I will
do my best to ensure my own safety and that of the other members of the party. I will at all times act with courtesy and
consideration for others and do my best to uphold the good name of the School.
Date:
Signed by Student

Name

General Consent Form for Domestic Field Trip. 11-January-2016 Edition 2 of 2