Annual Parental Consent form

North Walkden Primary School - Annual Parental Consent Form 2018 - 2019

Name of child_________________________________________________________  Class_______________

For journeys away from the school site lasting up to one day without an overnight stay:

I am willing to allow my child to take part in activities away from the school base during the year.  I also give permission for the Year Teacher or Headteacher to sign on my behalf any forms of consent required by the hospital authorities in the event of my child being taken ill or injured during the course of the journey to the extent that a surgical operation or serum injection becomes necessary, provided the delay required to obtain my signature might be considered likely, in the opinion of the doctor or surgeon concerned, to endanger my child’s health or safety.  I understand that during the period of the activities away from the school base, my child will be in your charge through the appointed members of staff and under your instructions.  Individual consent will be sought for each trip involving transport and will be accepted via the online parent booking system.

Signed________________________________________________________ Date____________________

Emergency Medical Details:

My child has been actively immunised against tetanus.   Please provide date if known          Yes/No*                    

Is your child allergic to penicillin?                                                                                                                Yes/No*

Is your child on any medication?  Please provide details                                                                            Yes/No*

 

Does your child suffer from any of the following?

Fainting / Convulsions / Fits (please indicate)                                                                                              Yes/No*

Speech difficulties                                                                                                                                        Yes/No*

Impaired vision                                                                                                                                            Yes/No*

Impaired hearing                                                                                                                                          Yes/No*

Asthma / Hayfever / Eczema (please indicate)                                                                                            Yes/No*

Diabetes                                                                                                                                                      Yes/No*

Bladder / Bowel difficulties                                                                                                                           Yes/No*

Anaphylactic Reaction                                                                                                                                  Yes/No*

Is your child allergic to plasters                                                                                                                   Yes/No*

Any other medical problems:

Signed________________________________________________________ Date____________________

*Please delete as necessary.                                                                                      

General Data Protection Regulation:  I consent to the information held for both my child and parents / carers to be used as detailed in the Data Protection policy for the benefit of my child’s education.

Signed_________________________________________________________Date____________________

Food Tasting: I give permission for my child to participate in food preparation and tasting with due consideration given to any allergies and dietary requirements that I have advised school of.

Signed_________________________________________________________Date____________________

School Photography and Video ConsentI give permission for photographs/video footage to be taken of my child during school activities.  These may be used by the school for internal purposes such as display, record keeping, and staff training or for the school to use to be published by the newspaper to promote events happening at school.  Photographs may also be used on the school website.  (No names will be displayed with the pictures on the website).

Signed________________________________________________________ Date____________________

Please note if you do not give permission for your child’s photograph and / or video footage to be used, your child may have to withdraw from some school activities.

Internet Consent:  I agree that my child can use the internet under the supervision of the school and in line with the School’s Online Safety & Mobile technology Policy.

Signed_________________________________________________________ Date____________________

Collection of Child:   My child will only be collected by the people who I have put down as emergency contacts.  If my child is going to be collected by someone else I will inform the school in writing. I have read the school’s safe arrival and collection policy.

Signed__________________________________________________________ Date __________________

Year 5 and 6 ONLY :  If you wish to give permission for your child to walk home please indicate below. Any changes to this must be given in writing.                   YES                      NO

Signed__________________________________________________________ Date __________________

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Worsley Road North, Walkden

Worsley, Manchester, Lancs, M28 3QD

Tel: 01204 571039

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