22 October 2015

Dear Parent/Carer,

Ypres Information Evening Thursday 5 November

As we continue preparations for the upcoming history visit to the battlefields in Northern France
and Belgium (Wednesday 18 Friday 20 November), I am writing to invite you and your son/ward
to a meeting at Isleworth & Syon School on Thursday 5 November 2015. The meeting will take
place in the school hall at 6.00pm.
The purpose of the meeting is to share with you:

The itinerary for the 3 days

Details of accommodation and travel
Recommended packing
Our expectations

Please note that students who do not own a UK passport must bring their passport along with
them on the evening. All students must also bring their E111 card with them to the meeting.
This meeting is a great opportunity to ask any questions that you may have regarding the trip. If
you are unable to attend the evening, please send apologies to me directly, via the email address
below. Please note that all Ypres correspondence is now hosted on the schools website, for easy
reference. You can access all of the letters by visiting www.isleworthsyon.org/?tag=ypres-2015.
Attached to this letter is a Parent/Carer Category A Consent Form. It is imperative that this form
is completed, in full, and returned to the school reception before the meeting.
Thank you for your support, and I look forward to seeing you on the evening.
Yours faithfully,

Mr A Nowicki
Assistant Curriculum Leader: History
anowicki@isleworthsyon.org

PARENTAL AGREEMENT FORM (CATEGORY A)

School:

Isleworth & Syon School

School visit to:

Ypres, Belgium

Dates of visit:

From:

Teacher in charge:

Mr A Nowicki

18/11/2015

to:

20/11/2015

Full name of student: ___________________________________________________________________________

Date of Birth:

___________________________________________________________________________

Home Address:

____________________________________________________________________
____________________________________________________________________

Home Telephone Number: ___________________

Emergency Telephone Number: _______________________

I, the parent/carer of: __________________________________________________________ (full name of student)

1.
2.

3.
4.

5.

Hereby give permission for my son/daughter/ward to participate in the visit detailed above, between the dates
shown, or between any other such dates (including an extension of time) as may be substituted heretofore;
Note that neither the Council nor the teacher named above is liable for any claim or claims of whatsoever
nature arising during the visit referred to above by virtue of the attendance of my son/ward except incidents
arising from the negligence of the Council or its servants;
Warrant that the information given overleaf is correct to the best of my knowledge;
Agree that the teacher named above (or any other teacher who may from time to time be in charge of the
visit) may act on my behalf in all matters affecting or concerning my son/daughter/ward, including medical
attention. I understand that all reasonable efforts will be made to contact me before taking any action but that
in particular cases this may not be possible;
Agree to the Council making any further enquiries that it considers necessary to establish whether my
daughter/son is medically fit to participate in the visit referred to above in the light of any information given
overleaf. In the event of the Council deciding, in its absolute discretion, that he is not medically fit to participate,
I understand that any sum paid by me in respect of any costs of expenses of the journey will be refunded to
me in full (less a deduction covering administrative expenses and deposit).

MEDICATION
If your son/ward requires any medication during the journey, it is your responsibility to provide drugs in a suitable
container, clearly labelled with: his name, the name of the drug, the dosage, and the frequency to be given. An
adequate supply must be provided, to cover the whole trip, if necessary. Please give the name, address and telephone
number of his General Practitioner (GP):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Telephone Number: _____________________________________________________________________________
Please give your son/wards Medical Number (as shown on the Medical Record Card).
_____________________________________________________________________________________________

DETAILS OF ILLNESS/HOSPITAL TREATMENT

Please insert below details of any illness or hospital treatment suffered or undergone by your son/daughter/ward within
the past two years, or any re-existing medical condition. If there are none, please mark None.
Dates of illness or
duration of stay in hospital
(approx. if necessary)

Nature of condition or type

of illness

Name and address of

hospital (if appropriate)

Name and address of

doctor or surgeon

TETANUS
Has your son/ward had an anti-tetanus injection within the past ten years?

YES / NO

If yes, please give approximate date: _________________________________________________

INFECTIOUS DISEASES
To the best of your knowledge, has he been in contact with anyone suffering from
an infectious disease during the past three weeks, or has there been any infectious
disease in the house during that time?

YES / NO

If yes, please give details: __________________________________________________________

ALLERGIES
Please give below a list of substances, including drugs, foodstuff and other substances to which your
son/daughter/ward has suffered an allergic reaction at any time. If he suffers from hayfever, please state Hayfever
below.
_____________________________________________________________________________________________

ASTHMA
Does your daughter/son suffer from asthma?
If yes:

Is the condition stabilised?

Has your doctor given the approval for the trip?

YES / NO
YES / NO
YES / NO

PHOBIA
Does your son/daughter/ward suffer from any phobia (e.g. heights)?

YES / NO

TRAVEL
Does your son/daughter/ward suffer from travel sickness?

YES / NO

SWIMMING
Can your son/daughter/ward swim 25 metres?

YES / NO

DIETARY REQUIREMENTS
Does your son/daughter/ward have any dietary needs?

YES / NO

If yes, please give details: __________________________________________________________

Signed: _________________________________________________ (Parent/Carer)

Date: ________________