Parental and Medical Consent Form 2024

Medical & Parental Consent

for DofE Expeditions with East Coast Outdoors CIC
Completion and return of this form will secure a place on a DofE Expedition run by East Coast Outdoors CIC, as well as acting as parental and medical consent.

This confidential form will accompany your child on the DofE Expedition run by East Coast Outdoors CIC and is necessary should we need to contact you while your child is in our care during the expedition.

No participant will be allowed to take part without this form being completed, signed by the parent or guardian and returned to East Coast Outdoors CIC.

Any details included within this form are shared with your childs school, Expedition Manager and East Coast Outdoors CIC Staff.
Full name of Participant*
School Name*
Please provide the name of your child's school, college or organised group.
Expedition Level*

BronzeSilverGold
edofe number this is your DofE registration number so an assessor report can be provided
If you do not have this number please leave the space blank
Participant Date of Birth

DayMonthYear
Date
Participant Home Address*

Building number or name

Street Address

TownCounty

Post Code
Parent/Guardian Name (1)
This is the person we will call in an emergency. You can add a second name and contact details further down the form if needed.
Email address (1)
example@example.com
Mobile number (1)
I give permission for photos to be taken of the above-named child during the expedition and understand these may be used for promotional purposes by East Coast Outdoors CIC via social media and, or the company website www.eastcoastoutdoors.co.uk*

YESNO
Does your child have a CARE PLAN on file at School?

YESNO

Please provide all information requested below. This may be needed in case of an emergency. Provide the most up to date and accurate information so the Expedition Manager and team leaders are aware of anything which may arise or your child needs support with.

It is the responsibility of the parent/guardian to inform East Coast Outdoors CIC of any changes relating to health issues before the expedition takes place. Please email info@eastcoastoutdoors.co.uk if anything changes ahead of the expedition taking place.
Name of registered Doctor Surgery*
Conditions requiring special consideration. This can be medical, physical or mental health related*
Please provide detail.
Has the participant seen a health professional in the last 6 months?*
Please provide detail.
Please provide full details of any medication being taken Include the name of the medication dosage and frequency it should be taken*
Who will carry the medication during the expedition?*
This can be the team leader, school staff or participant
Does the participant have a disability which may require reasonable adjustment? *
Please provide detail.
Is the participant allergic to anything? *
For example: NUTS, Pollen (hay fever), dairy products, please provide food intolerances.

A selction of non-prescriptive drugs are carried by Expedition Managers to help alleviate minor symptoms. A small selection of sanitary wear is avalible at all times as part of Expedition Manager kit. Participants need just ask.

Please indicate which medicines you give consent for an adult to administer if required. If you do not want us to provide anything, please tick NONE.
Please tick those medicines you are happy for an adult to administer:-*

ParacetamolIbruprofenAntihistamineSavlonPlastersNONE
If any other parent or guardian needs to be contacted in case of an emergecy please put their details below.
Parent / Guardian Name (2)

First NameLast Name
Relationship to participant is
Mobile number (2)

This section requires the parent or guardian to provide consent for the participant to take part in the expedition.

To make yourself happy with our working practices, you can find all documents relating to our safe operating procedures on our website.

East Coast Outdoors CIC holds its own Insurance Policy through Activities Industry Mutual (AIM) under cover number AIM101018. Every participant who undertakes an expedition is covered in the event of negligence by one of our employees or agents.

You are required to show that you have read the following declarations by signing this form as proof of acceptance: -

ü Personal injury due to inappropriate behaviour by a participant is not covered - please see our Code of Conduct for more detail.

ü By signing and returning this document, you give consent for the above-named participant to take part in this expedition. You understand that appropriate training will be provided to complete the activity successfully, and that the type of activity your child will be undertaking is deemed as adventurous in its nature, and

ü You understand that this means heavy loads will be carried by the participant, possibly in poor weather conditions under remote supervision (staff won't always be present) sometimes in unfamiliar terrain.
Parent/Guardian Signature*

Powered by Jotform SignClear
Date*

DayMonthYear
Date of signature
TO ANY DOCTOR OR HOSPITAL: I hereby authorise the release of my child's pertinent medical information to the appropriate professional staff.

I give permission to the hospital to secure treatment for them and to order medications, injections, anaesthesia, or surgery for my child, as named above, provided that the delay required to obtain my signature might be considered, in the opinion of the doctor or surgeon concerned, likely to endanger my child's health or safety in the case of an emergency.

The signature below constitutes authorisation to perform any necessary treatment for my child during this expedition.
Parent/Guardian Signature

Powered by Jotform SignClear
Date

DayMonthYear
Date of signature
If you wish to have a confidential conversation prior to the expedition or provide any further information or changes relating to the participants health, please email info@eastcoastoutdoors.co.uk and mark the email with the participants' full name.
Should be Empty:

Medical & Parental Consent