Culford Teens 13-16 – Consent and Medical Agreement for Under 18s


CARE OF UNDER 18S STATEMENT

PLEASE READ THIS STATEMENT CAREFULLY AND COMPLETE AND DIGITALLY SIGN THE FORM. WE CANNOT ACCEPT A FORM WITHOUT A SIGNATURE.

  • Every student will be given a wristband containing the school emergency number (07985 026835)
  • Students are given safety advice as part of their pre-arrival information and first day induction. This can be downloaded from our website www.selectenglish.co.uk.
  • The activity programme is compulsory.

SUPERVISION

  • We endeavour to have a same-sex member of staff living on each corridor but it is not always possible.
  • Students must attend all off-site excursions unless they are feeling ill. When ill, a member of Select English staff will remain on site.
  • Staff/student ratios will generally be 1:15 on Culford Young Learners and 1:20 on the Culford Teens Course. However, ratios will be determined by the risk assessment carried out for each activity.
  • Students will receive three meals a day. A tuck shop is available during breaks for students to buy additional snacks if required.
  • There will be a male and female member of staff with on-call overnight responsibility in each boarding house. Both male and female staff will patrol the corridors after lights out.

Consent and Medical Form

Please check that the details below are correct:

Student Name:

Date of Birth:

Student Mobile No:

Title and Full Name of Parent/Guardian:

Relationship to Student:

Your Email:

Emergency Contact Number:

Does the person on the emergency phone speak English?

Which language(s) does the person on the emergency phone speak?

Does your child take any regular medication?

If yes, please give details:

In the event of a cold, minor injury or illness, can we give any of the following medications to
your son/daughter?

Has your child taken Paracetamol or Ibuprofen before?

PLEASE DO NOT SEND ANY NON-PRESCRIPTION MEDICATION WITH YOUR CHILD/CHILDREN. IF THEY ARE UNWELL, WE WILL ARRANGE FOR THEM TO SEE A DOCTOR.


EMERGENCY MEDICAL TREATMENT

Can Select English authorise emergency medical treatment in your absence?

If you have ticked No, please advise what action should be taken?


ALLERGIES:

Does your child have any allergies?

Do you carry an EpiPen for your allergy?


GENERAL HEALTH:

Does your child have any medical conditions?

DIETARY REQUIREMENTS:

Does your child have any special dietary requirements?


PHOTOGRAPHY:

Select English will take photos during courses for use in promotional materials and social media. We will inform all students before we take any photos and what they will be used for. If they do not wish to feature they can inform our staff.  Our promotional materials include our brochure, website (http://www.selectenglish.co.uk), flyers, posters and newsletters. Our Social Media sites are Facebook and Instagram. https://www.facebook.com/Selectenglish/ and https://www.instagram.com/select_english/?hl=enb. You can contact us for further information about photography or to advise us if you prefer not to be included in any photography at info@selectenglish.co.uk

INSURANCE:

Does your child have a European Health Insurance Card (EHIC)?

If yes, please provide the card number:

Do you have private Health Insurance?

If yes, please provide the name of the insurer and policy number:

AIRPORT TRANSFERS:

All students under 18 must use the transfer service offered by Select English unless travelling with a parent or guardian.

 

CARE OF UNDER 18s

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Signature Certificate
Document name: Culford Teens 13-16 – Consent and Medical Agreement for Under 18s
Unique Document ID: fda496bd412ca1ff0669f91ecc321d9389b2e852
Timestamp Audit
27th February 2018 3:40 pm BSTCulford Teens 13-16 – Consent and Medical Agreement for Under 18s Uploaded by Select English - marta.pytel@selectenglish.co.uk IP 217.146.99.10