Medical/ Consent Form
Newquay Forest School
Name of child/young person
First Name
Last Name
Age
Date of Birth
Address
*
Street Address
Street Address Line 2
Town/City
County
Post Code
Parent or Legal Guardian Name
*
First Name
Last Name
Parent/ Legal Guardian Contact Number
*
Email
*
example@example.com
Optional - In the case that the primary carer (above) cannot be reached then please contact the following Next of Kin:
Next Of Kin Contact Number
Please list any dietary requirements:
Please list all known medical conditions (including food and/or drug allergiesand include all over the counter or prescription medication taken regularly):
Please list any additional considerations or educational needs:
STATEMENT OF CONSENT: I hereby give my permission for the person in my care (named above) to take part in outdoor and adventurous activities with Newquay Forest School. This may involve prolonged periods of physical exercise, activities involving levels of risk, use of sharp tools and eating wild food. I also hereby grant permission for any medical attention including administration of first aid,use of ambulance and the administration of anaesthesia and/or surgery (under therecommendation of qualified medical personnel) to be administered to my child in my absence, in the event of an injury or illness, until such time as I can be contacted. I also give consent to my child traveling by any form of public transport and/or motorvehicle driven by a member of staff:
*
I have read, understood and agree with the Statement Of Consent.
Signature - Please Use Your Mouse To Sign Below (Don't worry, we don't mark neatness!)
*
No Photo's Please!
Please check here if you DO NOT want Newquay Forest School to take photos of your children that may be shared with the wider community via the internet, emails, videos, printouts or other such media.
Would you like to be added to our mailing list for news of future events?
*
Yes
No
Back
Next
Click here to read our
Terms and Conditions
Submit
Should be Empty: