Medical Questionnaire – Just Dive In

Parent or Guardian Name

First

Last

Parent or Guardian Email

Parent or Guardian Phone

Child's Name

First

Last

Class

Medical Information

Does your child have any medical conditions?

Does your child have any known allergies?

Does your child have any specific dietary requirements not covered above?

Consent

The field trip and activities covered by this consent include day trips and residential visits during the current school year. You can withdraw consent for individual events by emailing the school office.

Class I your

I agree that my child may:

Take part in school trips and other activities that take place off school premises
Be given first aid or urgent medical treatment during any school trip or activity

Signature of named parent or guardian

Clear Signature

Date Signed