Scottish Schools Orchestra Trust Summer Course Consent Form 1

Participant Details

Participant first name*

Participant surname*

Age at the start of the summer course*

Gender*

Male
Female

Contact details

Please provide contact details for the period of summer course

Parent/guardian(s) name(s)*

Your Email*

Home address*

Please give your current home address

Phone Numbers*

Please give details of how you can most easily be contacted during the course (mobile, home and/or work numbers).

Emergency contact*

Please give details (name, relationship and phone number) of an emergency contact in case we cannot reach you during the course.

Travel Arrangements

Travel arrangements at the start of the course*

Please select one

The participant will arrive with a parent or other adult
The participant will arrive by another method

If "other", please give details:

Travel arrangements at the end of the course*

Please select one

The participant will travel home with a parent or guardian
The participant will travel home with another adult
The participant will travel home unaccompanied

If the participant is not leaving with a parent or guardian, please give details below.

Health and wellbeing

Please give details of any dietary requirements, or other special requirements

Please give details of any conditions that we should be aware of such as anxiety, stress or any other mental health needs that require emotional and/or physical support

Room sharing preferences

Dormitories/rooms are arranged by gender and age groups. We do our best to meet requests about sharing rooms but cannot promise. Please give names below of anyone the participant would particularly like to share with.

Name, address and phone number of GP*

Date of last tetanus injection*

Please enter as dd/mm/yy, "never", or "unknown"

Allergies, medical conditions or pastoral care needs

Please give details of any allergies, other medical conditions, or pastoral care needs of which the nurse should be aware, including details of any medication being taken or brought on the course. If your Child is old enough to self medicate the Nurse still needs to be aware of medication being brought on the course.

Consents

We require your consent to the statements below. This consent is valid only for the dates of the upcoming SScOT course. If for any reason you cannot give this consent please contact [email protected] before submitting this form.

Analgesia, antihistamine and cold/cough remedies*

I give my consent for the nurse to administer simple analgesia (paracetamol or ibuprofen); antihistamine (zirtek, clarityn or piriton); cold/cough remedies

Tetanus injections*

If my child sustains a cut or scratch that may require a tetanus injection, I give my consent for the nurse to take my child to the local GP practice or A&E department for this to be administered.

Emergency treatment requiring an anaesthetic*

If my child needs emergency treatment which may require an anaesthetic, I give my consent for the nurse to sign the consent form in my absence, in order that treatment is not delayed.

Declaration

I am the named participant’s parent/guardian and this form is complete to the best of my knowledge*

I understand that the data provided on this form will be distributed to the course directors, nurse and house parents to help them provide the highest quality of care during the course. The information will only be held for the duration of the course and subsequently destroyed.