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    Consent Form

    Uploaded by

    piyushk752009
    Ppppsndb Idyrvene Euejen3i. Euejme 7.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Consent Form

    Uploaded by

    piyushk752009
    4 views1 page
    Ppppsndb Idyrvene Euejen3i. Euejme 7.

    Original Title

    CONSENT FORM

    Copyright

    © © All Rights Reserved

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    Ppppsndb Idyrvene Euejen3i. Euejme 7.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views1 page

    Consent Form

    Uploaded by

    piyushk752009
    Ppppsndb Idyrvene Euejen3i. Euejme 7.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    PARENT’S CONSENT FORM

    I acknowledge receipt of the program itinerary and have carefully read the same. My signature below indicates genuine and voluntary
    desire on my part to enroll my child/ward for the program.
    I fully understand the inherent risks associated with outdoor based adventure programs and with travel by flight, train, and in any vehicles
    on highways and hilly terrain. I have sought information regarding the safety standards, practices and norms followed by Wandering Bee
    Holidays and its associates and I am fully satisfied with the same. In case of any untoward incident, I release Wandering Bee Holidays, its
    employees, agents, associates, contractors and directors from any liability from claims arising from my child’s/ward’s participation in the
    program and related activities conducted by them.
    I have read the rules and regulations regarding the participation, fee payment and cancellation policy and agree with the same. I have read
    and conveyed the points related to the conduct on the program to my child, and we agree to abide by them.

    Any claim or any controversy involving this agreement shall be conducted in Hyderabad/ Secunderabad. I have carefully read the letter
    above, understood it and sign below.

    PARTICIPANT’s NAME: Date of Birth: DD / MM / YYYY Gender: BOY/ GIRL

    School: Class/Section:

    Residential Address: _____________________________________________________________________________________________________________________

    Contact Telephone: Res:_____________________________________ email: _________________________________________________________________

    Previous experience of any outdoor activities, if any _________________________________________________________________________________

    Parent’s Name: ____________________________________Mobile: _____________________________email:________________________________________

    SIGNATURE:________________________________________________ PLACE:_____________________________________ DATE:_____________________________________

    Participant’s Medical History


    We will rely on the information provided by you in this form. If required, your signature on the form also gives the physician, selected by
    Wandering Bee Holidays, permission to hospitalize or provide medical treatment to your child/ward. Please use an extra sheet if you wish
    to bring anything to the notice of the camp doctor.
    Blood Group: ______________ Motion Sickness: YES / NO
    1. Please state clearly if there is anything you wish that the camp authorities should know regarding your child’s health and medical
    needs.

    2. Please specify if your child is allergic to any substances, foods or medicines. What remedial actions do you adopt in case of such
    allergy?

    3. Has the child been hospitalized in the past year. If yes, provide details on a separate sheet?

    4. Does your child suffer from asthma or epileptic fits? If yes, please mention the medicines your physician recommends or the
    child is currently using.

    5. Provide information of any muscle / bone / ligament related problems or recent fractures, if any.

    6. Does your child sleep walk or has a bed-wetting problem?

    7. When was the last time your child got an anti-tetanus shot? _______________________
    If your child is currently using any medication, please mention this and ensure that it is carried to the program.
    If your child uses prescription glasses, please have him/her carry an extra pair.
    In case we need to contact your family physician / doctor, please provide details.

    Name: _________________________________________________________ Tel: _________________________________________

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