Parent/carer permission slip - DofE 2019
DofE 2019 Parent/Carer sign up form.

If you have any questions - please contact us at info@ipswichacademy.org.uk

Name of child *
Your answer
Child's date of birth *
MM
/
DD
/
YYYY
The visit dates are below, please indicate of there are any that your child CANNOT do:
Child's Doctors name and address is: *
Your answer
Parent's name *
Your answer
Parent's email address *
Your answer
I have received and read details about the above visit(s).I consent to my child taking part in the visit(s) and the activities indicated. I acknowledge that the staff will be liable in the event of any accident only if they have failed to take reasonable care of my child during the visit. I consent to my child receiving medical treatment that, in the opinion of a qualified medical practitioner, may be necessary. *
Required
Please give your home address and contact phone numbers. If you will be away from home during the dates stated, please give an alternative address where you, or a relative or friend acting for you, can be contacted.
Home address details
Name of contact: *
Your answer
Address and post code *
Your answer
Telephone number: *
Your answer
Alternate telephone number: *
Your answer
Alternate contact details
Name of alternate contact: *
Your answer
Alternate Address and post code *
Your answer
Alternate contact telephone number: *
Your answer
Alternate contact additional telephone number: *
Your answer
In your child's interest, it is important that the organising staff and employer should know whether he or she suffers from any illness or medical condition. Please use this space to state, in confidence, any health or other matter concerning your child of which accompanying staff should be aware. Please indicate here also if your child is receiving medication, with details and dosage, and/or has any specific dietary requirements. If none, please state 'none'. *
Your answer
I understand that if any of the medical information or contact details changes it is my responsibility to inform the school immediately *
Required
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