To be completed by the Parent/Guardian of students under the age of eighteen.
If you are over 18 then tick the box below and skip this section.
I agree for my Son/Daughter to take part in the visit to Moscow and Star City. I agree to my Son’s/Daughter’s participation in the activities described in the itinerary. I acknowledge the need for him/her to behave responsibly.
1. Medical Information About Your Child
Any conditions requiring medical treatment, including medication.
Please outline any special dietary requirements of your child.
Has your child ever had any problems with common first aid items e.g. Elastoplast, Paracetamol.
Has your child any known allergies?
To the best of your knowledge, your Son/Daughter has not been in contact with any contagious or infectious diseases or suffered from anything in the last four weeks that may be contagious or infectious?
I will inform the Group Leader as soon as possible of any changes in the medical or other circumstances of my child between now and the commencement of the trip.
I agree to my Son/Daughter receiving medication as instructed and any emergency dental, medical or surgical treatment, including anesthetic or blood transfusion, as considered necessary by the medical authorities present.
I understand the extent and limitations of the insurance cover provided.
I am aware that this visit may include time when the students have some time unsupervised and I agree to this aspect. 3. Parent/Guardian Information
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