Medical Consent Form

Given the short amounts of time, the Company spends with young people at any one time, it is unlikely that medication will need to be administered.

We do, however, ask all Clients to complete the form below so that we can take any medical needs into consideration when planning and delivering educational activities. This information will be held securely and confidentially and will only be shared with those who have a role or responsibility in managing the administration of medication or delivering educational activities to the ‘Student’ This form must be completed by the Client prior to the commencement of any activity with the Company.

Name of parent/carer *
Name of parent/carer
Name of student *
Name of student
Medical Condition(s) *
Does the student have any medical condition(s), the Company needs to be aware of?
Declaration of Consent *
Where relevant, I give my consent to the Company administering medication in accordance with the prescriber’s instructions. I confirm that the information and instruction given are accurate and up-to-date. I will inform the Company in writing of any changes to this information and instructions. I understand that the medication may be given by non-medically qualified staff. I agree to not hold staff responsible for loss, damage or injury when undertaking agreed administration of the medication unless resulting from their negligence. I will ensure adequate supply of the medication that is within its expiry date. Whether my son/daughter has a diagnosed medical condition or not, I consent that if, in an emergency, my son/daughter should be in need of surgery, or other medical treatment (including anaesthetic, x-rays. etc.) and if it is not possible to consult the Client first, the Company shall have authority “in loco parentis” to give consent on my behalf for such treatment as is absolutely necessary. It is understood that the Company will always attempt to obtain parental consent first, where it is possible to do so.
Please provide electronic signature
Date *