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					                                 Grosvenor House
                         Consent Form for Trips and Activities
         To include art and crafts, sports and personnal development programmes




I agree to my Son / Daughter / Ward

Full Name
Date of birth


My son / daughter / ward is in good physical health                Yes / No

             If NO please give details of any medical condition from which the child
             is suffering together with details of treatment and medication currently
             being taken or carried.




Is your son/daughter/ward allergic to any medication/food/nuts/bee stings, etc.

If Yes please give details.




Some visits may involve staff cars being used to transport pupils and seat belts
must be worn in the correct manner at all times.

I give my consent for this      Yes / No
Swimming and water based activities

Is your child able to swim 50 meters                              Yes / No
Is your child water confident in a pool                           Yes / No
Is your child water confident in the sea                          Yes / No
Is your child safety conscious in water                           Yes / No

I understand the Kent County Council does not provide personal accident cover

Declaration

I agree to authorise members of staff during the course of these activities and give
consent on my behalf for anaesthetic to be administered or for another urgent
medical treatment to be given to my child on the advice of a qualified medical
practitioner.


Signed                                                   Parent /Guardian

Date

Name

Address




Tel Home:
Tel Work:
Tel Mobile:

Emergency Phone:

				
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