Bilton Grange | Online Joining Information and Forms | French Trip Consent Form

French Trip Consent Form

5th Form French Trip 2020

I give permission for the pupil(s) named below to attend the above trip and have paid a deposit of £200

Please complete this form and pay the deposit no later than Friday 6th September 2019 if you wish your child to attend the trip.

Child's Full Name *

First

Last

Passport Number

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Birth

Parents' Names

First

Last

Parents' Names (copy)

First

Last

Medical and Dietary Details

Name of Doctor

First

Last

Details of any medical conditions, allergies (including allergy to any medication) and curent medication:

Details of anything concerning the health of a close relative of the child which may make it necessary to cancel/cut short the trip:

Details of any special dietary requirements:

Please confirm whether your child will have a valid EHIC card at time of travel (EU nationals only)

Swimming ability: My child can swim:

50 metres and confident in water
Less than 50 metres/ unable to swim

Declaration

I confirm my consent

I agree to my child being given the medication detailed above and give permission for any emergency dental and medical treatment as considered necessary by the medical authorities present. I understand the extent and limitations of the insurance cover provided.

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