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Day Trip application form

Parents (not students) must complete this form with their child's details.

CURRENT MEDICAL INFORMATION ABOUT YOUR CHILD:

DOES YOUR CHILD SUFFER FROM ANY MEDICAL CONDITIONS / MEDICAL ALLERGIES

Please provide FULL details of the symptoms AND treatment AND medication of each condition.
(Please note the information provided below is specific to this trip and must include all/any medical conditions that your child has.)

DOES YOUR CHILD SUFFER FROM ANY FOOD ALLERGIES?

Such as allergy to Shellfish, Peanuts, Strawberries, eggs etc.
(please provide FULL details of the symptoms AND treatment AND medication of each condition.
Please note the information provided below is specific to this trip and must include all/any medical conditions that your child has.

DOES YOUR CHILD HAVE ANY FOOD PREFERENCES?

Select one of the following*
Have you included in the above any NEW medical conditions which the school have not previously been made aware of? Please tick relevant box.(If Yes, we may need to contact you to discuss this further).*
Does your child have a Treatment Plan?*
Does your child have an Epipen*
Does your child have an inhaler?*
If your son takes regular medication, please confirm which sentence best describes the administration of your child's medication.

EMERGENCY CONTACT DETAILS

CONTACT 1.

CONTACT 2.
I undertake to inform the Trip Leader as soon as possible of any changes in the medical circumstances of my child or if they have been in contact with any contagious or infectious diseases between the submission of this form and the start of the trip.*

PLEASE NOTE: Failure to disclose sufficient information at this stage may result in your child being withdrawn from the trip in the event of any discrepancy between the medical/dietary needs and the information provided to us. If necessary the Trip Leader may contact you to discuss medical and dietary issues in greater detail and whether it is safe for your child to participate in the visit.