EDUCATIONAL FIELD TRIP PERMISSION FORM TO BE RETURNED TO TEACHER

I give/do not give (circle one) consent for ___________________________________ of class ________ to take part in the

Educational Field Trip planned for Dubai Aquarium and Underwater Zoo on 19/05/2014 and leaving at 9:30 am and returning at
1:00 pm.

In an emergency and if I cannot be contacted, I/we consent to the teacher in charge making a decision in the best interests of
my son/daughter regarding medical treatment and/or emergency transportation.

Contact numbers on the day of the Educational field Trip for Parent(s):

Work _____________________________________________________________________

Home _____________________________________________________________________

Mobile _____________________________________________________________________

Contact details for family doctor:

Name_____________________________________ Telephone number __________________

Address ____________________________________________________________________

Does your son/daughter currently have (or has your son/daughter recently had) any of the following:
Asthma or bronchitis YES NO
Diabetes YES NO
Heart condition YES NO
Life threatening allergies YES NO
Fits, fainting or blackouts YES NO
Severe headaches YES NO
Other illness or disability YES NO
Has your son/daughter been given any specific medical
advice to follow in an emergency YES NO
Does your son/daughter receive any ongoing medical treatment YES NO

Date of most recent anti-tetanus injection _______________________

If the answer to any of the above questions is yes, please give any relevant details below.








Signed .. Date ..
(Person with Parental responsibility)