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Geography China trip 2013

Permission Form: please return to Mr Jowett


Student Name: ________________________________ PERMISSION CHECKLIST Please complete the following permission checklist which is not completely exhaustive, but is indicative of the type of opportunities which may be available to students during the trip. 1. I am aware that students will be staying in tourist accommodation YES / NO

2. I am aware that students will be using a variety of transport


including plane, coach, and train. 3. Do you give permission for your son/daughter to visit the sites listed in the itinerary?

YES / NO

YES / NO

4. Do you give permission for your son/ daughter to travel in a


rickshaw on the Hutongs visit? YES / NO YES / NO

5. Do you give permission for your son/daughter to cycle around


Xians city walls on hire bikes/tandems? (This is an area offlimits to motorised vehicles. Cycle helmets are not available.)

6. Any medical conditions or allergies that we should know about for the visit? YES / NO If YES, please give details below: ___________________________________________________ 7. Will any other medications need to be taken whilst in China? If YES, please give details below of medicines and doses: ___________________________________________________ 8. May paracetamol be given for a headache or minor pain? 9. May travel sickness tablets be given? 10. May Imodium tablets be given for diarrhoea? 11. Please initial to confirm that contact with your GP is being made and that you are taking advice from the GP with regard to vaccinations YES / NO YES / NO YES NO Initials: ________ YES / NO

12. Emergency Contact Numbers:


1) Name: _____________________________________ Day: _____________________ Evening: _________________

Mobile:____________________________

2)

Name: _____________________________________ Day: _____________________ Evening: _________________

Mobile:____________________________ Student mobile telephone number: __________________________

13. In the event of a medical or dental emergency I give permission for my


son/daughter to receive any medical treatment authorised by the attending medical doctor or consultant. We will, of course, make every attempt to contact you in the event of any emergency situation. Signature: _______________________________ Date: _________________ (Parent / Guardian) 14. Expectations about student behaviour: This is an educational trip and the students behaviour should be fully satisfactory, sensible and appropriate for being in China and experiencing a variety of different communities and environments. Students are part of a group and it is important that their attitude and behaviour towards each other is conducive to the success of the trip. Please note that abuse of alcohol or illegal substances will be regarded as serious misconduct and the student may be required to return home immediately at parental expense. Once back at school severe disciplinary measures will follow. Please sign to confirm that these points have been discussed and are fully understood. Signatures: Student: _____________________________ Date: __________ Parent/Guardian: ______________________ Date: __________