Medical Details And Consent To Travel Form printable pdf download

Medical Details And Consent To Travel Form

Medical Details and Consent to Travel Form

Parent / Guardian & Student Details

Full Name of Parent / Guardian

Emergency Telephone Number (incl. country code)

Email Address

Full Name of Child

Medical Details

1. Does your child have a condition or illness that requires medical treatment?

Yes

If yes, please give details:

2. Does your child suffer from any allergies?

Yes

If yes, please give details:

3. Is your child taking any medication at present?

Yes

If yes, please give details:

Travel Authorisation

I authorise my child to travel to the UK to attend an English Language Programme organised by Brighton Language College during the specified dates.

I have arranged for a BLC representative, carrying a BLC ID to meet my child at the airport and transport them to the school.

I will be accompanying my child.

My child is travelling in a group and will be accompanied by ___________________ who is a group leader / person responsible for my child.

We, the parents/guardian, agree that in the case of illness our child should be attended by a doctor or hospitalised or operated on in an

emergency, and may be given medication according to a qualified doctor’s advice in an emergency including the admission of anaes-

thetics and blood transfusions.

We, the parents/guardian, agree to inform the school of any change in our child’s medical condition before his/her arrival at the school.

Signature

Date

__ __ / __ __ / __ __

In case of any queries on the day please contact BLC on the following number: +44 (0)7962 811474.

Please e-mail this form to admissions@brightonlc.co.uk / FAX +44 (0) 1273 693606

Medical Details And Consent To Travel Form