Generic Trip Payment Form

This form could b used to take payment and accept permissions from parents.

Parent Name* Pupil Name* Pupil Year Group* Please select the Trip*

By ticking the Medical Consent field, confirm that I delegate responsibility for authorising serious emergency medical treatment to the adult(s) in charge of the school party. I understand that every effort would be made to contact me before such treatment was authorised.

Medical Consent*I agreeI do not agree

Does your child suffer from any medical conditions?*YesNo

If Yes, give details of medical conditions here*

Does your child suffer from any intolerances or allergies?YesNo

If Yes, give details of intolerances or allergies here

Please rate the following
	Medication 1	Medication 2	Medication 3
Name
Dose
Timing
Other information