The Halley Academy Trips & Visits Consent Form 2023/2024

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Please complete this form for all trips and visits your son / daughter will be attending.

Email *

Name of trip/ visit *

Email *

Student's First Name *

Please give the student's full first name.

Student's Surname *

Please give the student's surname.

Student's Date of Birth *

YYYY

Student's Small School *

Please select your child's current Small School at the time of completing this form.

Easley

Franklin

Turing

Hawking

Student's Year Group *

Please select your child's current year group at the time of completing this form.

Student's Medical History *

Please state if any medical conditions or none.

Student's Dietary Requirements *

Please state if any / none.

Name of Parent / Carer completing this form *

Your relationship to child *

Your emergency contact mobile number *

Your emergency contact landline or work number *

Please give your daytime contact number for the date(s) of the trip.

Alternative contact name

Alternative contact relationship to child

Alternative contact mobile number

Alternative contact landline or work number

Occasionally we use photographs from activities such as this in displays, newsletters and external publicity. Please indicate whether you are happy for your child's photograph to be used for such purposes. *

I do NOT wish my child's photograph to be used

I am HAPPY for my child's photograph to be used

Do you consent to any emergency medical treatment necessary during the trip? *

Yes

I wish my son / daughter to be allowed to take part in the above-mentioned academy trip / visit. Having read the information contained in the letter, I agree to them taking part in all or any of the activities described. I have ensured that they understand that for their safety and the safety of the group, any rules or instructions given by the adults in charge are obeyed. I understand that while the staff and helpers in charge of the party will take all reasonable care of the young people, unless they are negligent, they cannot be held responsible for any loss, damage or injury suffered by my son / daughter arising out of the journey. I understand that in completing this consent form I am committing to the payment attached to the trip. *

Please read the above terms and conditions carefully.

Yes, I agree to all the terms and conditions of this academy trip / visit

After the trip: *

I give permission for my child to be dismissed straight from the academy upon returning from the trip or visit.

I do not give permission for my child to be dismissed from the academy. My child will be collected by myself or another designated person.

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