Year 9 Camp Consent Form 2023

Our 2023 Year 9 Camp will take place from Monday 10th to Friday 14th July 2023 at 'Essex Outdoors' in Danbury, Essex.

Please take the time to read and complete all parts of this online form carefully and accurately.

All sections marked with a * are mandatory and you will not be able to submit this form if these sections have not been completed.

Student Details

First Name(s)* Surname*

Photograph Consent

I consent to my child having their personal information, including photographic images, being published in any of the following:

Please tick boxes to indicate your consent*Fulston Manor School newsletterFulston Manor School websitePhotographs being supplied to the pressFulston Manor School social media accounts (Facebook, Instagram and Twitter)Fulston Manor School Open Days (where we provide information about academic achievements to the public)

Please note, where a box has not been ticked, we will assume you do not provide your consent.

Medical Questionnaire

Student's Full Name* Date of Birth* Student's Doctor (please include surgery name, address and contact number)*

Does your child suffer with any physical disability, impediment or medical condition of which we should be aware?*YesNo

If yes, please provide further details

Does your child have any of the following? (please tick all that apply)*Asthma or BronchitisHeart conditionFits, fainting or blackoutsSevere headachesDiabetesAllergies to any known drugs or medicationAny other allergies, e.g., material, food, insect bites, etcAny recent contact with contagious disease and infectionsNone of the above

If you have selected any of the above, please provide us with further details

Has your child received vaccination against Tetanus in the last ten years?*YesNo

Is your child receiving medical treatment of any kind from either your Family Doctor or Hospital?*YesNo

Has your child been given specific medical advice to follow in emergencies?*YesNo

If the answer to either of these questions is YES, please give the details below, including dosage of any medicines/tablets.

Paracetamol will only be given in extreme circumstances and as a 'one-off'. Please note that a telephone call to parents/carers will still be made at the time.

Do you wish for your child to be given paracetamol as pain relief, if needed?*YesNo

I agree to the person in charge giving consent on my behalf for an anaesthetic to be administered, or for any other urgent treatment.*YesNo

Does your child have any dietary conditions requiring special catering arrangements?*YesNo

If yes, please provide further details

Swimming Capability

Select select the most accurate statement*My child is a strong swimmerMy child is a competent swimmerMy child is a weak swimmer*My child is a non-swimmer*

*If you selected that your child is a 'weak' or 'non-swimmer' please select one of the following statementsMy child feels safe in the water wearing a buoyancy aidMy child does not feel safe in the water even wearing a buoyancy aid

Parent/Carer Consent

Parent/Carer Name* Parent/Carer Email Address* Parent/Carer Address* Parent/Carer Emergency Contact Number 1* Parent/Carer Emergency Contact Number 2 Second Emergency Contact Name* Second Emergency Contact Number*

Please tick to agree to the following statements*I consent to my child taking part in the Year 9 Camp at Essex Outdoors, Danbury, Essex. I have ensured that my child understands that it is important for their safety and for the safety of the group that any rules and any instructions given by the staff in charge are followed.I understand that, while the school staff and helpers in charge of the party will take all reasonable care of students, unless they are negligent they cannot be held responsible for any loss, damage or injury suffered by my child during the visits/activities.I agree to pay for any damages which may be occasioned solely through the misconduct or carelessness of my child to the person or property of any other parties, on the understanding that such agreement should not be interpreted as in any way precluding possible access to insurance claims or other means of redress should such access be deemed more appropriate.

Today's Date*

Fulston Manor School A Fulston Manor Academies Trust School