22 October 2014

Dear Parent/Carer
Lunch time concert at The Grange - Midhurst
I am writing to invite your son/daughter to perform in a lunchtime concert at The Grange on
20 November 2014. The concert is for the elderly group at the centre who very much enjoy listening
to the students perform. We are asking students that are in the flute ensemble and Jazz group to
take part.
Students will be picked up by minibus at 1pm, the concert starts at 1.30pm and lasts for 30 minutes
after which the students will be taken back to College for approximately 2.20pm where they will
return to their normal Period 5 lesson.
Please can you confirm that your son/daughter is able to perform at The Grange on 20 November by
completing the reply slip and consent form and returning it for the attention of Mrs Tidbury to
student reception by Friday 7 November. If you have any queries please email me at
sally.tidbury@mrc-academy.org
Thank you for your continued support.
Yours sincerely

Mrs S Tidbury
Subject Leader Music
-------------------------------------------------------------------------------------------------------------------------------------Lunch time concert at The Grange Midhurst 20 November 2014
Student Name: ............................................................................. Form Group: ........................................
Will/will not (delete as appropriate) be able to attend the Grange lunch time concert on 20
November 2014.
Signed: ............................................................................................... Date: ..............................................

Trip to:

Lunchtime Concert at The Grange - Midhurst

From (date/time):

20 November 2014

1pm

Until (date/time):

20 November 2014

2.30pm

Cost

N/A

Party
leader/department

Mrs S Tidbury - Subject Leader, Music

CONTACT INFORMATION

DOCTORS DETAILS

Student name

Name of doctor

Date of birth
Doctors address
Student mobile no

Doctors telephone
number

Full home address

Emergency contact
numbers during trip

MEDICAL INFORMATION/CONSENT please answer the questions and sign below:

Has your son/daughter had any of the
following:

Y/N

If the answer to any of these questions is yes please give details(or attach on a
separate sheet)

Asthma or bronchitis?
Heart Condition?
Fits/fainting/blackouts?
Severe headaches?
Diabetes?
Allergies to any medications?
Any other allergies?
Recent contact with contagious
diseases/infections?
Other illness or disability including any current
medical treatment?
Specific medical advice to follow in
emergencies?
Special dietary requirements?
Prone to travel sickness?
Has your child been vaccinated against tetanus
in the last 10 years?
Is your child currently having any medical
treatment/taking medication (please provide
full details)
I consent to any emergency medical treatment
necessary during the course of the visit

SIGNED:

Parent/Carer

PARENTAL AGREEMENT please read and sign below

Transport
I consent to the pupil travelling by any form of public transport and/or in a motor vehicle driven by the party leader or any other responsible
adult member of the party who is authorized by law and duly insured to drive.
Accident/Illness
I consent to the pupil receiving medication as instructed and any emergency dental, medical or surgical treatment, including inoculations,
general or local anaesthetic, surgery or blood transfusion, as considered necessary by the medical authorities present.
Remotely supervised time (senior College only)
I consent to the pupil having remotely supervised time in the daytime in a group of pupils with the prior permission of the party leader
Personal effects of the pupil
I acknowledge that the pupil will be responsible for the safety of his/her own money and personal effects. I will not hold the College
responsible for losses unless caused by the negligence of the College.
Insurance
I understand the extent and limitations of the insurance cover provided, and know of no information that may affect the insurance.
Signature of parents/carer
I, the undersigned who have parental responsibility for the above named pupil have completed the information requested above and overleaf.
I have read and understood and I consent to the matters set out above and overleaf.
I agree to inform the College as soon as possible of any changes in the medical or other circumstances between now and the commencement
of any journey.
SIGNED:

(Parent/Carer)

Student agreement
I the above named student agree to observe the code of conduct for visits. I will do my best to ensure the safety of myself and other members
of any party. I will at all times act with courtesy and consideration for others and do my best to uphold the good name of the college.
SIGNED:

(Student)