One day Activity/Outing Information and Consent Form.

One day Activity/Outing Information and Consent Form.
This part to be kept by parent/guardian.
Please complete the lower portion of this form and return it, signed, to the group leader
______________________________________by: _____________________________
Cost ______________________________________________
Name of Group _____________________________________
Activity ___________________________________________
Date _____________________________________________
Pick up point and time _______________________________
Finish point and time ________________________________
Signed(Leader) ____________________________________
Date _____________________________________________
Under 3’s must be accompanied by an adult
IT IS IMPORTANT YOU RETURN THE PARENT & GUARDIANS SECTION OF THIS
CONSENT FORM BEOFRE THE DATE OF THE TRIP—CHILDREN WILL NOT BE
ALLOWED ON THE TIP IF A CONSENT FORM HAS NOT BEEN RECEIVED BY US
Parent or Guardian’s Consent
Please complete, sign and return this to the group leader before ___________________
I have noted the arrangements above and give my permission for my child to take part
in _____________________________________________________________________
Please state if your child has any disability or condition which might be affected by the
activity
______________________________________________________________________
Please detail any medical treatment your child is having at the moment
______________________________________________________________________
______________________________________________________________________
Emergency contacts:
1.
Name __________________________Relationship to child _________________
Address __________________________________________________________
Phone numbers ____________________________________________________
2.
Name __________________________Relationship to child__________________
Address __________________________________________________________
Phone numbers ____________________________________________________
Signed __________________________________________________(Parent/Guardian)
Date __________________________________