Education, classic form

School excursion consent template

An excursion permission note with trip details, contacts on the day, health and allergies, medication handling, agreements and photo consent.

17 questions, 11 required, as a classic form

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The School excursion consent template as a respondent sees it, top of the form

Every question

  1. Student name (required)

    Full name

  2. Class (required)

    Dropdown: 5A, 5B, 5C

  3. The name they answer to

    Short answer

  4. Parent or carer completing this form (required)

    Full name

  5. Best number on the day (required)

    Short answer

  6. A second number on the day (required)

    Short answer

  7. Someone else we can call if neither answers

    Short answer

  8. Their number

    Short answer

  9. Does your child have any of these? (required)

    Multiple choice: Asthma, Anaphylaxis, Diabetes, Seizures of any kind, Heart condition, Migraine, Travel sickness, Blackouts or dizzy spells, None of these

  10. Any allergies? (required)

    Multiple choice: Penicillin, Other medicines, Foods, Insect stings, None

  11. What should staff do about anything you ticked?

    Long answer

  12. Year of the last tetanus immunisation

    Short answer

  13. Will your child need medication during the excursion? (required)

    Single choice: No, Yes

  14. If yes, name the medicine, the dose, and when and how it is given

    Long answer

  15. I have read and understood (required)

    Multiple choice: If my child behaves in a way that puts themselves or others at risk they may be sent home, I will be told, and I will be responsible for the cost of getting them home, If staff decide my child needs to come home early because they are unwell, I will be responsible for the cost of getting them home, The principal may cancel or change the excursion at short notice for safety reasons or for reasons outside the school's control, The Department does not provide student accident insurance or ambulance cover, and I may want to arrange my own

  16. Photographs on the day (required)

    Single choice: Fine for the class newsletter and the school website, The class newsletter only, Please do not photograph my child

  17. Signed by the parent or carer (required)

    Signature

What you fill in

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