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Student Consent_Medical Information_Form 2024

The document is a Student Medical Information Form and Educational Visits Consent Form that collects essential medical information and consent for participation in educational visits. It requires details about the student's medical history, emergency contacts, and agreement to the terms of the visit, including responsibility for behavior and potential medical treatment. Parents or guardians must sign the form to authorize participation and acknowledge understanding of the associated risks and responsibilities.

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5 views

Student Consent_Medical Information_Form 2024

The document is a Student Medical Information Form and Educational Visits Consent Form that collects essential medical information and consent for participation in educational visits. It requires details about the student's medical history, emergency contacts, and agreement to the terms of the visit, including responsibility for behavior and potential medical treatment. Parents or guardians must sign the form to authorize participation and acknowledge understanding of the associated risks and responsibilities.

Uploaded by

ahsanmahrukh9
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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EV7-09

Student Medical Information Form


1. MEDICAL INFORMATION

Please provide information on the following where appropriate:

Student Name ______________________________________________________________________


Tetanus (within 3 years)Yes No Date of Inoculation if known ____/____/____
Allergies __________________________________________________________________________
__________________________________________________________________________________
Any medical treatment at present _______________________________________________________
__________________________________________________________________________________
Previous illnesses ___________________________________________________________________
__________________________________________________________________________________
Any other relevant medical information __________________________________________________
__________________________________________________________________________________
Parent/Guardian: Emergency Contact Tel No (day)_________________________________________
Parent/Guardian: Emergency Contact Tel No (eve)_________________________________________
Parent/Guardian: Emergency Contact Tel No (mobile)_______________________________________
2. DOCTOR

Name of Doctor ____________________________________________________________________


Tel No ___________________________________________________________________________
Doctor’s Address ___________________________________________________________________
__________________________________________________________________________________
3. DECLARATION

I confirm that the above is correct to the best of my knowledge, and authorise the Organiser, on my
behalf to arrange emergency medical treatment should it become necessary.

Signature of parent/guardian ______________________________ Date _____/_____/____

Signature of student ______________________________ Date _____/_____/____


Student Educational Visits – Consent Form
1. STUDENT DETAILS

Student Name _________________________________Mobile No ____________________________

Course _____________________________________________________________________________

Date of Birth _________________________________________________ Age _________________

2. EDUCATIONAL DETAILS
Place of Visit ____________________________________________________________ Visit Number ___________

Main Purpose of Visit ______________________________________________________________________________

Date of Departure _________________________________ Return _______________________________________

Organiser(s) _____________________________________________________________________________________

3. AGREEMENT TO PARTICIPATION IN THE VISIT


I have received and read the letter from the Principal and Chief Executive concerning the visit described above, and confirm that:

• I agree to the participation of my young person in the visit;


• I accept responsibility for my son/daughter’s/own behaviour during the visit;
• I understand that all reasonable care will be taken by College staff to ensure the safety of those in the party;
• I understand that students will normally be collected from and returned to the College, unless for students under 18 at the start of
the course, I have expressly consented in writing to alternative arrangements, prior to departure;
• I accept that the insurance policy of the College does not cover personal accident or injury to members of the party of damage/loss
to personal property unless it can be shown that this is due to the negligence of the College’s employee(s);
• I have completed and returned the medical information form (EV7-09) attached;
• I accept responsibility for any damage caused by my young person and will pay any expenses as a result of the above, including
any costs of him/her/self being sent home early due to misconduct;
• I authorise the organiser, on my behalf, to arrange emergency medical treatment should it become necessary.

For visits abroad only

• My young person has a passport valid for the duration of the trip;
• My young person has European Health Insurance card (formerly E111 form);
• If a foreign national passport is held, the appropriate visa will be obtained prior to the visit.

Signature (Parent/Guardian/Self*) _________________________________ Date ______/______/_____

Name (BLOCK CAPITALS) ________________________________________________________________

* If you were 18 or over at the start of the course and financially independent, it may be more appropriate for you to sign the
form on your own behalf.

Please return this form to the organiser of the visit (see above)

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