Chalet Booking Form
Child’s name:____________________________________________
(exactly as it appears on passport)
Child’s age: _____________________________________________
Date of birth:____________________________________________
Nationality: _____________________________________________
Passport number: ________________________________________
Passport issue date:
___________________________________
Passport expiry date:
___________________________________
Passport country of issue:
______________________________
Parental consent form completed + attached
yes/no
Medical consent form completed + attached
yes/no
Activities consent form completed + attached
yes/no
Medical information form completed + attached
yes/no
EHIC photocopy attached
yes/no
*Departing from school
yes/no
Picked up from school
yes/no
PARENTAL CONSENT
School Trip to France and Italy
Dates from ..................... to ………………
I acknowledge receipt of the information relating to the above-mentioned school trip and wish
my daughter/ son …………………………………………………..
to be allowed to take part. I agree to her/him taking part in any or all of the activities proposed.
I have ensured that ………………………………………… understands that it is important for
her/his safety and the safety of the group that s/he obeys any rules and instructions given by the
staff in charge.
I understand that, whilst the staff and the member of staff in charge of the group will take all
reasonable care for their health and safety, they cannot be held responsible, unless found to be
negligent, for any injury, illness, damage or loss suffered by my daughter/son during or arising
out of the journey. I therefore agree to indemnify Abberley Hall, its employees and agents
against all liability for injury (including death), illness, loss to person or persons or damage to
properties caused by my daughter/son unless this was due to the negligence of Abberley Hall or
any of its employees or agents.
Signed: ………………………………….. Date: ……………………..
Outdoor Activities
Permission
Name: ……………………………………………………………..
I am happy for my daughter/son to take part in any activities which may include
skiing, ice skating, sledging, swimming, mountain walking, white water rafting,
cycling and walking on snow shoes. I also consent to guided rock climbing under
qualified instruction.
Signed …………………………………… Date ………………………………
ABBERLEY HALL
Request to Administer Medication
Name of Parent:
………………………………………………….…..
Name of Pupil:
………………………………………………………
Details of Medication
Name of Medication: …………………………………………….
Details of Medication Dosage: …………………………………..
Storage: …………………………………..
Administration Method: ………………….
Times to be given: ……………………….
Any other instructions: ………………………………………………….
Name of Doctor prescribing medication: ……………………………….
Address: …………………………………………………………………
Telephone No: …………………………………………………………..
The above information is accurate to the best of my knowledge at the time of writing and I give
consent to the school to administer the medication in accordance with the school policy. I will
inform the school in writing of any changes to the above information.
Signed: ……………………………….
(Parent or Guardian)
Date: …………….
Name of Child:.............................................................................
Please add any medical notes concerning your daughter/son which it might be
necessary or helpful for the staff on the trip to know.
If your child suffers from any food allergy or has a special diet, please give details
below:
Signed…………………………………… Date…………………………
In the event that we cannot contact you directly, please give below the name and
contact details of 2 people who can act on your behalf:
1…………………………………………………………………………………………
2…………………………………………………………………………………………
ABBERLEY HALL
Request to Administer Vitamin Pills
or Complementary Medicines
Name of Parent:
………………………………………………….…..
Name of Pupil:
………………………………………………………
Details of Medication
Name of Medication: …………………………………………….
Details of Medication Dosage: …………………………………..
Storage: …………………………………..
Administration Method: ………………….
Times to be given: ……………………….
Any other instructions: ………………………………………………….
Address: …………………………………………………………………
Telephone No: …………………………………………………………..
The above information is accurate to the best of my knowledge at the time of writing and I give
consent to the school to administer the medication in accordance with the school policy. I will
inform the school in writing of any changes to the above information, (further forms can be
downloaded off the school website). Replenishing of stocks of Vitamin Pills or Complementary
Medicines will be the responsibility of the Parent. Out of date medication will be disposed of by
the School Nurse in accordance with the Administration of Medication procedure.
Signed: ……………………………….
(Parent or Guardian)
Date: …………….
Abberley Hall
In Loco Parentis Form
In the event of medical emergency parents will always be informed. If parents cannot be
contacted, it is essential for Mr. and Mrs. Andrews and/or the Headmaster and/or his deputy to
be able to act in loco parentis.
I ……………………………………parent or guardian of ………………………………
agree that in an emergency Mr. and Mrs. Andrews, the Headmaster or his deputy may act in loco
parentis for the above-named child.
I give my permission for the above named child to undergo medical/dental/optical treatment as
deemed necessary by the medical matrons.
First aid and homely medicines may be given as required by the medical matrons, except the
ones I have initialled (see list below).
This statement remains valid until either your child leaves the school, or you withdraw consent.
Signed: ……………………………………….
Date……………………………..
The list below are the ‘over-the-counter’ medicines used at Abberley Hall. Please initial the
medicines you DO NOT wish the above-named child to have administered.
Analgesics: General
Paracetamol suspension
Calpol fastmelts
Nurofen meltlets
Nurofen for children syrup
Mouth
Liquid Anbesol
Oil of Cloves
Burns
Reliburn gel
Dressings
Jelonet
Inadine
Opsite
Cream
E45
White soft paraffin
Aqueous cream
Nausea
Magnesium trisilicate
mixture
Analgesics: Topical
Deep heat rub and spray
Hirudoid cream
Hirudoid gel
Arnica cream
Disposable ice pack dressing
Antihistamine
Piriton syrup
Piriton tablets
Ears
Cerumol ear drops
Decongestant
Olbas oil
Karvol capsules
Vicks vapour rub
Menthol crystals
Verrucas
Bazuka gel
Travel
Stugeron 15mg tab
Antiseptic
TCP liquid
Mycil athlete’s foot/powder
Surgical spirit
Distilled witch hazel
Opsite vapour permeable
spray
Betadine dry powder spray
Savlon Spray Wash
Eyes
Saline eye pods
Broline
Antiseptic Cream
Savlon
Throat lozenges
Kaysils throat lozenge
Kaysils menthol eucalyptus
Kaysils extra strong
Cough
Benylin chesty
Sudafed
Glycerin lemon & honey
with glucose