Medical/Dietary Form (Form 4) - Residential Trips

Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

Password must contain the following:

12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character

TRIP NAME

Please add the name of the residential trip below.

1. STUDENT INFORMATION

Full Passport Name:

As stated on the passport

Date of Birth:

dd/mm/yyyy

Nationality:

As per the passport that holds the UAE Visa.

Passport Number:

Passport Expiry Date:

dd/mm/yyyy

Passport Copy Attached

Upload a copy of the passport numbered above.

Visa Copy Attached

Upload a copy of the student residence visa.

For overseas trips, a copy of the student’s passport and residence visa MUST be attached.

If you are ordering a new passport for your son/daughter prior to the trip departing please inform the trip organiser (required for insurance purposes).

2. PARENT/GUARDIAN CONTACT INFORMATION

Parent/Guardian Full Name:

Relationship to Student:

Mother, Father etc.

Home Address:

Residential address in the UAE

Mobile Number:

Email Address:

3. EMERGENCY CONTACTS

Contact 1 Full Name:

Relationship to Student:

Family, friend etc.

Mobile Number:

Telephone Number:

Home, Work etc.

Contact 2 Full Name:

Relationship to Student:

Family, friend etc.

Mobile Number:

Telephone Number:

Home, Work etc.

4. DIETARY REQUIREMENTS

Does your child have any special dietary requirements:

Please provide details of any dietary requirements (including religious dietary requirements, if applicable):

Please include any religious dietary requirements - i.e. Halal, no pork etc.

5. MEDICAL INFORMATION

Does your child suffer from travel sickness?

Please provide details of any travel sickness medicines/tablets and dosage, where appropriate:

Is your child receiving medical treatment, of any kind, either from your family doctor or hospital?

Please provide details of any medical treatment and medication:

Please include dosage of any medical/tablets, where appropriate.

Has your child been given specific medical advice to follow in emergencies?

Please provide details of any medical advice to be followed in an emergency:

Please include dosage of any medical/tablets, where appropriate.

Does your child have any allergies?

Please provide details of any allergies and dosage of any medicines/tables

Is there any other medical information that we should be made aware of?

Please provide details of any other medical information that we should be made aware of

6. CONSENT

Parents are required to read the following and add their name in the Parent/Guardian Signature field to confirm that the medical information is correct and that the information below has been read and understood.

DESC has a well-deserved reputation for being a caring school and staff will take every possible care of your child during this visit. However, parents must understand that accidents do happen. Please understand that DESC cannot be responsible for accidents where DESC staff have not been negligent in their care of the students or which are caused by the action of a third party who is outside the control of the College.

Furthermore, whilst staff will encourage students to take all reasonable care of their belongings, DESC cannot be responsible for the loss or theft of personal items. We would advise that students do not take valuable items or things of sentimental value.

I acknowledge the need for safe and responsible behaviour on the part of students. If my child's behaviour is unsatisfactory, I agree that they risk being sent home from the trip, and I understand that this will be at our own expense.

To the best of my knowledge, my child is not suffering from any medical condition that makes them unfit to participate in this visit.

I agree to my child being given medicines, which can be bought over the counter, at the discretion of the staff leading the trip; for example Paracetamol or Strepsils.

I WILL INFORM THE PARTY LEADER AS SOON AS POSSIBLE OF ANY CHANGE IN THE MEDICAL CIRCUMSTANCES BETWEEN THE DATE SIGNED BELOW AND THE COMMENCEMENT OF THE JOURNEY.

Parent/Guardian Signature:

Date:

Save my progress and resume later | Resume a previously saved form

Contact Information