Flamingo Land Parental Consent – PiPeLine Bradford

Flamingo Land End of Year Trip

We are planning to take Year 11 pupils to Flamingo Land on Tuesday 16th June. They will need to arrive at the Bradford provision for 8.30am and will return to Bradford around 4pm (depending on traffic). Pupils need to wear clothing suitable to the weather, sensible footwear and, if needed, should wear sunscreen. We will have a small budget for lunch but pupils may need additional money. Any money or valuables will be brought at the pupil’s own risk. The trip will require a £20 refundable deposit, payable before going and returned if your child attends the trip. As the trip is to a theme park, please let us know within the form if there are any rides or activities your child should NOT take part in. If you are happy for your child to attend the trip please fill in the following consent form and pay the deposit by Thursday 11th June.

Young Person’s Name *

Your Name *

Address *

DOB. *

Your Relationship to the Young Person *

Mobile Number *

STATEMENT OF CONSENT

I hereby consent to the above named young person taking part in the above trip and I confirm I have read the details of the activity and give consent to this. I authorise staff to act on my behalf for the duration of the placement. I also agree that staff at PiPeLine Productions Academy are duly authorised on my behalf to seek any emergency medical treatment required on the advice given by a medical professional. I hereby agree to make good any damage caused by my child whilst attending this excursion.

Signature *

Print Your Name *

Date *

EMERGENCY CONTACT DETAILS

In the case of an emergency we will always strive to contact you as a priority using the above details. However, please provide us with one other emergency contact below should we not be able to reach you:

Name of second emergency contact *

Mobile number *

Please provide the following details in order for us to best support your child whilst on our programme: (please select all which apply) *

Your child suffers from epilepsy, fits or drowsiness
Your child suffers from allergies
Your child currently takes medications or is receiving medical treatment at present
There are other health problems that we may need to be aware of
No health issues

Parent/Carer has positively identified that the child has NO medical concerns that impact their health on this trip.

Relationship to the young person *

Details of epilepsy, fits or drowsiness *

Details of allergies *

Details of medications or medical treatment *

Any other health problems *

Name of child’s doctor

Doctor’s telephone number

The doctor’s surgery my child is registered at is

Refundable Deposit

A refundable deposit of £20, payable via electronic transfer or cash, is required for this trip. Should your child not attend, this deposit will be offset against the cost of their ticket if this has already been purchased. If your child attends, the deposit will be returned to you electronically after the trip. If you are paying via electronic transfer, please use your child’s name as the reference and send £20 to the following details:

Bank Transfer

Wyntermax Limited – Business Account – Sort Code: 40-18-00 – Account Number: 11182153

Cash Payment

I will send the deposit in cash with my child by Thursday 11th June.

Name