SHERE FUN HOLIDAY PLAYSCHEME

Note This sheet should be submitted with the Child Information sheet on this site

CARE INFORMATION

Please give details of any allergies, illness, special needs, dietry restrictions etc:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

DOCTOR

Please give details of Doctor and Surgery with whom registered:
____________________________________________________________________
___________________________________________________________________
___________________________________________________________________

MEDICATION

I will notify the scheme supervisor of any specific medication which may need to be administered to my child/ren, and understand I will need to complete an additional consent form.

Parent's Signature.____________________________________________________
Date________________________________________________________________

PERMISSION FOR EMERGENCY/OPERATIVE TREATMENT

In an emergency when a parent's attendance cannot be immediate, it is sometimes necessary to obtain treatment for a child from a Doctor or a Casualty Department of a hospital. As delay in these circumstances is highly undesirable, we would ask that your give your consent below in case such an emergency should unfortunately arise.

In the event of sudden illness or accident affecting my child, if recommended by a Doctor, I agree to emergency treatment, including any operative treatment and/or administration of a general anaesthetic to my child.

SIGNED____________________________________________PARENT/GUARDIAN
ADDRESS___________________________________________________________
___________________________________________________________
_____________________________________________________________
DATE______________________________________________________________

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