The Thomas Aveling School
Work Experience Placement for 10 th
-14 th
February 2014
To Work Experience Co-ordinator:
I have found the following placement for:
Name of Student: ………………………………………………………………………….
Tutor Group: …………
Name of Company: ……………………………………………………………………………………………………….
Company Address: ………………………………………………………………………………………………………..
Postcode :……………….
Telephone: …………………………………………..
Email: ……………………………………………………………..
Name of contact person and Job Title: :……………………………………………………………………….
€ Please tick if you have received permission from the Contact Name above. The School cannot make contact with an organisation unless the organisation knows we are going to contact them!
Parental Permission
I agree to (student’s name):_____________________________taking part in a work placement programme and understand that prior to attending, my son/daughter will have received a “work information sheet” and health & safety risk assessment on the placement.
€ I acknowledge the need for my son/daughter to behave responsibly
€ I agree to take responsibility for my son/daughter whilst on their way to and from their work placement and to undertake any costs in relation to the placement (e.g. subsistence, travel, specific equipment)
Medical Information and your Child
Does your child suffer from any conditions which the employer needs to be aware of – medical conditions, allergies, medication? YES/NO
If YES, please provide details:___________________________________________________________
Declaration
In the event of my child requiring emergency treatment and the Work Placement or Head
Teacher being unable to contact me, I give consent for a member of staff to approve the application of any emergency treatment, including anaesthetic, advised by the medical authorities for the wellbeing of my child. YES/NO
I can be contacted using the following numbers:
Home:…………………….Mobile:………………………………Work:…………………….
Home Address:………………………………………………………………………………………
Signed:__________________________Relationship to child:___________________
Name (print): ________________________________Date:___________________
Please return the completed form to the School by 23 rd
September 2013