Medical Consent Medical Consent Fill out the form below. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Student's NameDate of BirthDD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920On roll atName of Parent/GuardianAddressPhoneEmergency Contact 1 NameEmergency Contact 1 PhoneEmergency Contact 2 NameEmergency Contact 2 PhoneANNUAL CONSENTI will provide my child with a packed lunch and drink every day. I give my permission for the following actions:To receive emergency medical treatment.YesNoTo be allowed off-site for local community visits as required by his/her curriculumYesNoTo be transported by private car, public transport and/or mini busYesNoTo have his/her photograph taken during activities as a record of progress and achievement. I also understand that we may use these images for publicity purposes.YesNoTo be allowed off site for break and lunch without supervision.YesNoAre you happy that your child can cross roads safelyYesNoI am aware and give consent for my child to smoke or vape at designated times. (If NO, we will not be responsible for stopping them smoking).YesNoFor Hair and Beauty Students:To allow all hair and beauty treatments to be performed on him/herYesNoTo allow him/her to perform all hair and beauty treatments on othersYesNoMEDICAL INFORMATIONPlease could you provide the following information for your child. This will be kept confidential and will only be used in the event of an emergency.Doctor’s NameDoctor’s Phone NumberDoctor’s Name and AddressIs your child allergic to anything?Is your child taking any medication?Does your child have any medical or additional educational needs that we need to be aware of?Parent/Guardian SignaturePlease write your full name in BLOCK LETTERS.Date DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Submit CONTACT US Find out more information. Name* Email* Phone* Message* Send