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EV4 Educational Visits Consent Form

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0% completeEV4 Educational Visits Consent Form

This form is used to collect information regarding the upcoming educational visit and will only be used for this purpose. We need the information collected here to enable us to manage this process effectively. The information is for internal use only and will be stored on our internal servers. This information will be kept in line with our data retention policy.

We will only use your contact details to share information with you that is relevant to this process.

If you have any concerns please contact us before you proceed.

Please tick here to confirm you have read and understand this notice.

Basic Details

Student First Name

Student Surname

Date of Birth

Mentor Group

Visit Name

Journey home arrangements after the visit (outside normal school day)

Emergency Contacts

Emergency Contact 1

Name

Relationship to student

Telephone Number

Emergency Contact 2

Name

Relationship to student

Telephone Number

Student's Medical Details

Are there any activities in which your child cannot participate?

Yes No

If Yes, please give details

Where applicable, I give permission for my child’s name to be included in the collective passport to be held by the group leader

Yes No

If water activities are involved, is your child confident in water?

Yes No

Does your child suffer from any condition(s) of which the member of staff leading the visit should be aware?

Yes No

If Yes, please give details below of anything the leader needs to know in order to safely care for your child (e.g. Illness, travel sickness, night-time tendencies etc.)

Does your child need to take any medication?

Yes No

If Yes, please give full details

For each medication, please give its name, dosage details, time of day/circumstances for it to be administered and the method of administration.

I give my consent for a member of staff to administer the above medication

Yes No

Medication must be delivered to the group leader before the visit. By selecting 'Yes', you confirm that you understand that the staff leading the visit are not qualified medical practitioners but that they will take reasonable care in the administration of the medication and will endeavour to respond appropriately should emergency treatment be required.

I give my consent for my child to self-administer the above-detailed medication

Yes No

Is your child allergic to any medication?

Yes No

If Yes, please give details

Does your child have an up-to-date tetanus vaccination?

Yes No

If Yes, please give details of the date of the last injection

I consent to my child receiving emergency medical treatment, including anaesthetic and blood transfusion, as considered necessary by the medical authorities present

Yes No

I undertake to inform the school as soon as possible of any changes to the information provided on this form

Yes No

Any additional relevant information

Student's Dietary Requirements

If Other, please specify

Image Rights

Whilst you may have already given general permission for image rights at the start of the academic year, we will always seek additional written consent if a child’s image or name is to appear on an external online platform, in print or featured in any external media product. This includes (but is not limited to) marketing materials, media outlets and public appearances.
The photographs from this visit may be used on the school website / local press and your child's name and photograph may be used in the local press, the website or newsletter. The photographs may also be used by the Nova Education Trust’s marketing team for purposes of marketing the school to the general public.

I give consent for my child’s photograph & name to be used as outlined above

Yes No

Confirmation

I agree to inform the school immediately if any of the medical or contact information changes. I acknowledge the need for obedient and responsible behaviour on his / her part and I understand that there is some level of risk in every activity but that this will be managed to minimise the risks involved. I understand the extent and limitations of the insurance cover provided. I understand that as part of the planned transport arrangements, or in emergency, it may be necessary for pupils to be transported in staff vehicles.

Parent/Carer Name

E-mail Address

You will receive a confirmation e-mail to this address.