The Bishop of Hereford’s Bluecoat School Duke of Edinburgh Award
MEDICATION ON EDUCATIONAL VISITS
This form must be completed and returned before your son or daughter can take part in the expedition.
Trip: Duke of Edinburgh Expeditions From To
1. DofE Training Day 18th April and 19th April
2. DofE Training Expedition 16th May 17th May
3. DofE Assessed Expedition 20th June 21st June
Trip Leader: Mal Mason/Nic Howes Designated First Aider(s): Mal Mason/Nic Howes
Only the designated first aider(s) will administer medicines. Written records of administration of both prescribed & unforseen medications will be kept. If medication is administered a verbal handover will take place when the trip returns. Written records may be requested by Parent/Carer on return of the trip.
Name of Student: Form: Date of Birth:
1. Prescribed Medication
Medical Condition/illness: Name/type of medicine (as described on the container):
Date dispensed: Expiry date: Dosage and method (e.g. with food):
Timing (when to be given): Special Precautions:
Are there any side effects known?
Self-Administration YES/NO Procedures to take in an emergency:
1. Unforeseen Medication The designated first aider(s) will have a small stock of paracetamol and ibuprofen only to alleviate minor symptoms such as cold, period pain, headache, to be administered as described on package.
Child may receive: Paracetamol Yes/No (delete as appropriate) Ibuprofen Yes/No Calpol Yes/No
At the discretion of the first aider(s)
Should there be any query arising you will be contacted by a member of staff.
Contact Details
Contact 1 Name: Relationship to student: Telephone No: Work:
Mobile:
Home
Contact 2 Name: Relationship to student: Telephone No: Work:
Mobile:
Home
Name of GP: Telephone No. Address:
Postcode:
Name of Dentist: Telephone No. Address:
Postcode:
All medicines provided by the parent/carer or student MUST be given to the designated first aider(s) in advance of the visit (at a time advised by the trip leader).
Medicine must include the pharmaceutical notes and must be accompanied by a prescription.
If your son or daughter suffers from any specific allergies, travel sickness or disability which may affect him/her during the visit please give details. Date of last Tetanus (if known):
Details of any contagious or infectious illness suffered within the last three months.
If there are any special dietary needs please give details
Are there any activities (eg swimming) which your son/daughter may not participate?
If symptoms requiring painkillers persist beyond 48hours medical practitioner advice must be sought.
Verbal handover to parent/carer on return must take place – written record to follow if requested.
Please read the notes overleaf, sign and return to school prior to the first expedition.
Important Notes 1. The County Council accepts no responsibility for accidents or injury to students, or for the loss or damage of personal effects, unless the cause is negligence of the County Council or any member of its staff.
2. For school trips the school has taken out a School Journey Insurance with Ace Insurance SA to cover personal accidents and loss or damage of personal effects. The cost of this insurance has been included in the total cost of the trip. Further information may be obtained from the school.
3. In some situations emergency medical treatment, including anaesthetic, may be considered necessary by the medical authorities. If, in the case of an emergency, parents cannot be contacted, it is assumed that teachers will act ‘in loco parentis’. Naturally every effort will be made to contact parents/carers should the need arise.
4. Should any of the details you supplied change, please notify school as soon as possible.
Parent/Carer …………………………………………… Date …………………………………
Headteacher …………………………………………… Date ………………………………….
If this form is not signed by the Parent/Carer the student will not be able to take part in any of the expeditions.