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DofE Consent and Medical Information

ONLY TO BE COMPLETED PRIOR TO EXPEDITIONS

Please enter the following information and then submit the form. You will receive a copy of this form by email.

* denotes required field

Does your son or daughter suffer from any of the following?
Is your son or daughter taking any regular medication?*
Does your son or daughter suffer from any medical condition not listed above?*
Has your son or daughter been in contact with any infectious diseases?*
Has your son or daughter received a tetanus in the last 3 years?*

Please complete the contact information IN FULL, please do not insert 'as above' or 'similar'.

Emergency Contact 1

Emergency Contact 2

By submitting this form you are agreeing to the following -

PARENT DECLARATION

I agree to my son or daughter taking part in the activities described.

I understand that it is my responsibility to inform the organiser of any specific arrangements or issues affecting my son or daughter and I will inform them if there are any changes in circumstances as they arise.

I undertake to inform the organiser of any changes to the medical circumstances of my son or daughter.

I understand that the member of staff in charge will be acting in loco parentis and I agree to my son or daughter receiving emergency medical treatment which might include anaesthetics and blood transfusions.

Participation in outdoor activities does entail some form of risk and I do accept that accidents or injuries can happen, without any contributory negligence from the contracted provider or its staff.

I understand the extent and limitations of the insurance cover provided (Calday students only) and that the school is insured in respect of its legal liabilities only.