Residential Visit Consent & Medical Information
This form must be signed by the parent/guardian/carer (unless the participant is over 16 years of age and living independently, in which
case they should complete and sign themselves). Please return to the Visit Leader in advance of departure.
  • Your son / daughter will need to log onto eDofE to give you this
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  • Emergency Contact Details of Parent/Carer/Guardan

  • Address 2 is if you live at a different address to you son / daughter
  • Medical/Behaviour Information (Please answer Yes or No to each statement by deleting as appropriate.)

  • Has this involved any broken limb or injury of any kind?
  • This includes convulsions, seizures or absenting of any kind?
  • Including behavioural, learning difficulties or other conditions
  • such as sleepwalking, bed-wetting, etc?
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  • Doctors Information

  • Medical Treatment Whilst Participating in the Visit (Please answer Yes or No/Some)

  • E.G. headaches, insect bites, sunburn, cuts/grazes etc. If deemed necessary, do you give permission for establishment staff to treat such ailments with the following ‘over the counter’ products: paracetamol, Ibuprofen, antiseptic cream, calamine lotion, antiseptic wipes, insect bite antihistamine, sun cream, plasters?
  • Which of the products listed above you do not wish the participant to be given (or if other alternatives are acceptable or preferred instead):
  • Prescribed Medication

  • If you answered ‘Yes’ to the above question please read and complete the section below:

    It is important that this child is accompanied by any medication necessary, and that leaders are fully informed. Please make sure that there is sufficient medication, and that it is clearly labelled.
  • Name of Medication
    Dosage
    Time & Frequency
    Method od Adminstration
  • I give my consent for a member of staff to administer the above medication which I will give to the Visit Leader before the visit, with clear labels and instructions. I understand that the staff on the visit are not qualified medical practitioners, but that they will take reasonable care in the administration of the medication.
  • I give my consent for this participant to self-administer the above medication.
  • Swimming and Water Confidence

    It may not be necessary for participants to be able to swim on a visit or activity, but for some visits, they may need to be water confident. Please indicate their ability and confidence.
  • Dietary Information

  • Consent

    I have received full information about the visit, understand the nature of the visit and consent to the participant engaging in all of the activities described. I understand that the visit may be changed by the Visit Leader due to weather or other reasons. I understand and accept that there is some level of risk in every activity, but that all reasonable measures will be taken to minimize the risks involved and I will ensure that the participant understands that they must behave responsibly at all times and follow instructions during the visit. I fully understand to where and at what time my young person is to be returning from the visit and that I am responsible for the collection of my young person from this point. I am aware of the Insurance Cover in place for this visit. The policy details can be found on the school website under the information, policies and documents section.

    I agree to the participant receiving medication as instructed above and that they are not traveling against the advice of a qualified medical practitioner. I also agree to them receiving any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities if it has not been possible to be contacted.

    The information I have provided in this form is accurate at the time of signing and I have not knowingly withheld any information regarding physical fitness, medical issues or any other anxieties or pre-existing conditions. I agree to inform the visit leader as soon as possible of any changes between now and the start of the visit. In line with data protection guidelines, the information contained on this form will be kept with the visit leader (this includes taking the information out of the country where necessary) and the designated link person at the establishment for the duration of the visit for emergency purposes.

  • Please tick all those that are applicable, leave all blank if non apply.
  • You can use the Mouse/digital pen/finger to sign dependant on the device you are using
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