Idemnity form

Indemnity Form

Indemnity Form

Educational / Recreational Visits - Parental Consent Form

Please complete this form as fully as possible. The completing of this form will not only consent the pupil stated below to attend and participate in activities as described in documentation from the school / establishment, but also, provide essential information in the event of an emergency. If you have any queries as to the nature of activities or conduct of the educational / recreational visit, please do not hesitate to contact the group leader in charge of the visit. For the purposes of this form, the term ?visit? refers to both Educational Visits and Recreational Visits.
Name of Participant
Home Address
Postcode
Telephone Number/s



Details of Visit

To:
Date:

I hereby consent to the attendance of my son /daughter, upon the above visit when the person(s) in charge of the party will be appointed by Darlington Borough Council. I also agree to his/her participation in any or all of the activities involved. I acknowledge the need for obedience and responsible behaviour on his/her part.
Medical Information
a) Does your son/daughter suffer from any conditions requiring medical treatment?

Please specify : YES * NO *

If YES - please give brief details and describe the medication, dosage and frequency required:





I further consent to the giving of any such urgent medical or surgical treatment, including anaesthetic to my son / daughter, as considered necessary by the medical authorities present as a result of an emergency during the visit

b) Has your son/daughter been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be or may become contagious or infectious?

Please specify: YES * NO * Cont:


If YES, please give brief details



c) Is your son / daughter allergic to any medication?

Please specify: YES * NO *

If YES, please give brief details:



d) Has your son / daughter received a tetanus injection in the last five years?

Please specify: YES * NO *

If YES, please give brief details:



e) Please specify any dietary requirements for your son / daughter :





DECLARATION
On reading and completing the above information to the best of your knowledge, please read the text detailed below and sign to acknowledge your agreement and consent. If you have any reservations or queries in connection with the educational / recreational visit please contact the group leader in charge.

In consideration of the person in charge of the visit agreeing to the inclusion of my son / daughter as a member of the visit, I hereby undertake to indemnify him/her and any other member of the visit against any reasonable expenses incurred on behalf of my son / daughter during the visit.

With reference to insurance cover, my son / daughter will be covered for personal accident if the school takes out School Journey Insurance cover available from Darlington Borough Council. If this cover is taken, my son / daughter will be covered for personal accident and loss, damage or theft of personal belongings.


Signed: Parent / Guardian

Date:

ON COMPLETION OF THIS FORM PLEASE RETURN TO THE GROUP LEADER Back to top