Polar Explorers Consent Form

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CONSENT

 

Please use a separate form for each child

 

Child’s full name…………………………………………………………..

Child’s Address…………………………………………………………….

                                                       Postcode…………………………..

Emergency contact name……………………………………………..

Telephone………………………………………………………………….

GP’s name…………………………………………………………………

GP’s telephone……………………………………………………………

Any known allergies or conditions……………………………………

……………………………………………………………………………..

I confirm that the above details are complete and correct to the best of my knowledge.

In the unlikely event of illness or accident, I give permission for any appropriate first aid to be given by the nominated first-aider.

 

 In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible.

 

Signature of parent/guardian……………………………………………

 

                                   Date……………………………….…………


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