Parental And Medical Consent Form For A Trip printable pdf download

Parental And Medical Consent Form For A Trip

RADNOR YFC - PARENTAL AND MEDICAL CONSENT FORM FOR A TRIP

Trip details: Wales v Tonga Rugby Match

Address:

Millennium Stadium, Cardiff

Dates: Friday 22

November 2013

Departing from:John Beddoes High School @ 3.45pm and Llandrinddod Train Station (YFC

Side) @ 4.15 pm

Returning to: Llandrindod Train Station and Knighton. Leaving Cardiff at approx 10.30pm

Members of Radnor YFC are taking a group of young people to Cardiff as described above.

If your daughter/son is take part in the outlined activities, please fill the permission slip at the

bottom of this form and return it to the YFC Office by: 1

November 2013.

In an emergency Radnor YFC can be contacted on:

01597 829008



Name of Participant:

Address:

Telephone:

Age:

Date of Birth:

Male / Female

Two responsible adults who can be contacted in an emergency:

Name 1:

Address:

Telephone (home):

(work):

(mobile):

Name 2:

Address:

Telephone (home):

(work):

(mobile)

MEDICAL HISTORY

Name of Doctor:

Address:

Telephone:

Have you ever suffered from any of the following conditions? Diabetes, Asthma,

Migraine, Epilepsy, bad period pains or any other illness

YES / NO

If yes, give details

Are you allergic to anything? (e.g. antibiotics, penicillin, elastoplast, aspirin or any such

medicines, any particular food)

YES / NO

If yes, give details

Are you receiving any medical treatment or on any prescribed medication?

YES / NO

If yes, give details

Parental And Medical Consent Form For A Trip

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