Child's Full Name*

First Last

Child's Preferred Name

First

Date of Taster Session*

Current School or Nursery*

Emergency Contact Details

Primary Emergency Contact Name*

Prefix First Last

Relationship to child*

Phone Number*

Email Address*

Secondary Emergency Contact Name*

Prefix First Last

Relationship to child*

Phone Number*

Email Address*

Child's medical & dietary information

Name of GP / Doctor's Surgery where child is registered

GP Phone Number

GP Address

Street Address Address Line 2 City ZIP / Postal Code

Allergies*

Please enter N/A if your child has no allergies

Medications*

Please enter N/A if your child takes no regular medications

Other Medical details*

Please enter N/A if nothing for the team to be aware of.

Dietary requirements*

Please enter N/A if there is nothing for the team to be aware of.

Immunisations*

Please state if your child’s immunizations are up-to-date and the age or date of last Tetanus booster.

Sporting Activities

If your child is unable to take part in sporting activities, please give details.

SEND & Learning Differences

Please share any information you would like the teaching staff to be aware of during the taster session.

Administration of Medication

In the event of your child being ill or injured, and should it be considered necessary, please indicate by ticking the relevant boxes, your consent for your child to be given ‘over the counter’ medications under the supervision of a suitably trained first aider.

Medication Consents*

Paracetamol

Antihistamine

None of the above

Consent to General Treatment and First Aid

I give consent for my child to receive general health care and first aid services provided at the school by trained first aiders.

First Aid Consent*

Yes

Consent to Emergency Treatment

I authorise the Headteacher or Deputy Head to consent, on the advice of a medical practitioner, to my child receiving emergency medical treatment, including general anaesthetic, if the school is unable to contact me in time.

Emergency Consent*

Yes

Taster Day Information Form