Form E – Parental Consent for Category B and C Visits

Dear Parent/Guardian,

This form will give consent to the student stated below to attend and participate in activities as described in the documentation given to you by the School. It will also provide essential information in the event of an emergency. If you have any queries about the nature of activities or conduct of the Educational visit/trip, please do not hesitate to contact the group leader in charge of the visit.

To complete this form, you will need the following information:
(a) Passport or ID copy
(b) Signed authorisation form by a certifying officer
(c) Permission to leave the country from the Army for the boy's over 16 years old.

State the Name of the Trip
Please state the students name as per official Passport or Citizen ID i.e. the name should be the same as the document they will be traveling with otherwise, a change of name a parent will be changed with an extra EUR50.00 to make changes. Please state the students name as per official Passport or Citizen ID i.e. the name should be the same as the document they will be traveling with otherwise, a change of name a parent will be changed with an extra EUR50.00 to make changes. First Last
Student ID (e.g. s151010)
Upload a copy of the students ID or Passport.

Attach Files
Any boys that are 16 years of age or above will need permission to leave the country from the army offices. Upload a copy of this authorization.

Attach Files
Year Group

Year Group 1 2 3 4 5 6 7
Class

Class Black Green Jade Red White Yellow
Student's Date of Birth Student's Date of Birth / DD / MM YYYY
Students mobile number.
Students school email account (s....@englishschool.ac.cy)
Nationality
Passport / Citizen ID expiry date Passport / Citizen ID expiry date / DD / MM YYYY
Contact Details Information.
Notice for a student's Guardian: please add "n/a" at the parents' details i.e. Father's Name: type in 'n/a', Father's mobile number 'n/a' etc.

This is the description of your section break.
Father's Name Father's Name First Last
Father's mobile number
Father's email
Mother's Name Mother's Name First Last
Mother's mobile number
Mother's email
Guardian's Name (should be completed if a student is not living with their parents) Guardian's Name (should be completed if a student is not living with their parents) First Last
Guardian's mobile number (should be completed if a student is not living with their parents)
Guardian's email (should be completed if a student is not living with their parents)
Alternative emergency contact
This is in the event parents do not respond.

This is the description of your section break.
Emergency contact Emergency contact First Last
Emergency contact telephone number
Details of the Visit
I have read the information sheet and hereby consent to the participation of my son/daughter, in the above educational visit. I also agree with his/her participation in any or all of the activities involved. I acknowledge the need for responsible behaviour on his/her part.

This is the description of your section break.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Medical Information
Any conditions requiring medical treatment, including medication?

Any conditions requiring medical treatment, including medication? Yes No
If YES, please give brief details and describe the medication, dosage and frequency required:
Please outline any food or other allergies and special dietary requirements of your child:
Any recent illness or accident which staff should be aware of?
The type of pain/flu relief medication your child may be given if necessary:
Does your child suffer from travel sickness?

Does your child suffer from travel sickness? Yes No
If you have answered yes above, Have you provided him or her with sickness prevention tablets?

If you have answered yes above, Have you provided him or her with sickness prevention tablets? Yes No
To the best of your knowledge, has your son/daughter been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be contagious or infectious?

To the best of your knowledge, has your son/daughter been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be contagious or infectious? Yes No
If you answered 'yes', please give details. If you answered 'No', please state N/A.
Is your son/daughter allergic to any medication/Insect Venom/Food/Adhesive Plasters?

Is your son/daughter allergic to any medication/Insect Venom/Food/Adhesive Plasters? Yes No
If yes, please specify
Approximately when did your child last have tetanius infection?
Authorisation
Please note:
The passport control has informed us that any student under the age of 18 needs their parents to complete an authorisation letter that MUST be certified by your local municipality representative or an authorised certifying officer.

A certifying officer near our school is:
Mr Charalambos Karatzias
52A Athalassis Avenue
2023 Nicosia
Cyprus
Phone: 22420316
Mobile: 995603165

Other certifying can be found here: https://www.oncyprus.com/en/dir/cyprus_Nicosia_certifying_officers.html

More information about this will be given by the trip organizer.

The sample of the declaration form can be downloaded from our website: https://www.englishschool.ac.cy/policy-procedures (1st Policy: Educational Trips, the last download box: Copy of the Authorisation form to be signed by certifying officer)
Media
Upload a copy of the declaration form here

Attach Files
Declaration
I agree to my son/daughter receiving medication as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. I confirm that the contact details given below are to be used in the event of an emergency or in the event of my son/daughter being returned home for some other legitimate reason and that at least one of the named contacts will be available throughout the duration of the off-site visit.

This is the description of your section break.
Do you have any additional comments? Is there anything else about your son’s or daughter’s needs that it would be helpful for us to know about?
Email of person completing the form.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Media

Form E – Parental Consent for Category B and C Visits

Form E – Parental Consent for Category B and C Visits

Contact Details Information. Notice for a student's Guardian: please add "n/a" at the parents' details i.e. Father's Name: type in 'n/a', Father's mobile number 'n/a' etc.

Alternative emergency contact This is in the event parents do not respond.

Details of the Visit I have read the information sheet and hereby consent to the participation of my son/daughter, in the above educational visit. I also agree with his/her participation in any or all of the activities involved. I acknowledge the need for responsible behaviour on his/her part.

Medical Information

Media

Media

Contact Details Information.
Notice for a student's Guardian: please add "n/a" at the parents' details i.e. Father's Name: type in 'n/a', Father's mobile number 'n/a' etc.

Alternative emergency contact
This is in the event parents do not respond.

Details of the Visit
I have read the information sheet and hereby consent to the participation of my son/daughter, in the above educational visit. I also agree with his/her participation in any or all of the activities involved. I acknowledge the need for responsible behaviour on his/her part.