1st WILLASTON CUBS          ALTON TOWERS CONSENT FORM  2005

I give permission for my Son/Daughter ……………………………. to travel  with the above group to Alton Towers June 5th to 8th incl.  under the Leadership of Paul Aldridge.

If he / she is in contact with any infectious diseases within 3 weeks prior to departure I will inform Paul Aldridge.

Name, address and tel. no of GP: Dr………………………………Tel no: 01624 ……..………….

Address……………………………………………………...........................................................

National Health no…………………………………Date of last Tetanus injection............................

Any allergies or special needs .......................................................................................................

Paul Aldridge may administer simple first aid, apply an adhesive dressing and administer Paracetamol if necessary ...........yes  .........no                                           

During the trip I can be contacted at

Day Tel No  1   01624………….       Night Tel no 1  01624…………….

                   2   01624………….                           2  01624…………….

                       Mobile: ...............................

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In the event of sudden illness or accident I authorise Paul Aldridge to sign on my behalf, any documents required by Medical authorities to treat my son / daughter.

Signed ……………………........    Print name clearly…....................………………………

Address………………………………………………………………..........................…….

Mother / Father                      Date …………………………