Permission slip template

Permission Slip For a trip or activity ____ (School or group) (the “Group”) is planning ____ (Trip or activity) on ____ (Date). Please read the details below, fill in what is asked, and sign if you agree that your child may take part. Section 1: About my child 1.1 My child’s full name: ____ (Child’s full name) 1.2 My child’s date of birth: ____ (Child’s date of birth) 1.3 My child’s class or year: ____ (Class or year) Section 2: Health and care 2.1 Allergies, medical conditions, medicines or anything else the adults in charge should know to look after my child safely (write “none” if there is nothing): ____ (Health notes) 2.2 If my child needs to take medicine during the trip, I will give it to the adults in charge in its original container with written instructions: ____ (My child will bring medicine) My child will bring medicine 2.3 Dietary needs: ____ (Dietary needs) Section 3: In an emergency 3.1 Emergency contact, if I cannot be reached: ____ (Emergency contact’s name), phone ____ (Their phone). 3.2 My own phone number during the trip: ____ (My phone) 3.3 ____ (If I cannot be reached, I agree that the adults in charge may get urgent medical help for my child) If I cannot be reached, I agree that the adults in charge may get urgent medical help for my child Section 4: Getting there and back 4.1 The group will travel by ____ (How the group travels). Drivers will have a valid licence and insurance, and children will use the seat belts or restraints that the law requires. 4.2 The adults in charge will count the children at the start, at each stop and before leaving each place, and will keep a list of who is with them. Children will always be in a group with an adult and will not be left alone. 4.3 If my child will be collected by someone other than me at the end, I will tell the Group in writing before the trip. Section 5: Cost and what to bring 5.1 The cost of the trip, if any, is ____ (Cost per child). If my child needs money for food or the shop, I will send it in a labelled envelope, and the Group is not responsible for money or valuables that are lost. 5.2 My child should bring: ____ (What to bring). My child should wear clothes and shoes suitable for the activity and the weather. Section 6: Photographs 6.1 The Group may take photographs during the trip for its own records and newsletters. ____ (I agree that photographs that include my child may be taken and used inside the Group’s own newsletters and noticeboards) I agree that photographs that include my child may be taken and used inside the Group’s own newsletters and noticeboards Pictures will not be put on public websites or social media without separate consent. Section 7: What I understand 7.1 The Group will supervise the children and take reasonable care, and will tell me promptly about any accident or serious problem. An activity can carry some risk of injury even when everyone is careful, and I accept the risks that are a normal part of this one. 7.2 My child will follow the rules the adults in charge give. The Group may send my child home, at my cost, if my child’s behaviour is a danger to themselves or others. 7.3 I may withdraw my child at any time before the trip by telling the Group in writing. Signatures I am the parent or legal guardian of the child named above. I give permission for my child to take part. Parent or guardian ____ (Printed name) Printed name ____ (Parent or guardian signature) Signature ____ (Parent or guardian date signed) Date