Library Letter 2nd Page Y6 Willow

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Longfellow Drive, Worksop, Notts ,

S81 0AW
Tel: or Fax 01909 473955 or 01909 488780
Email: [email protected]

I give permission for my child:


Name:.......
Class: 6 Willow

To visit Worksop Library on 27th February 2015.


Medical Information
Does your child have Asthma? .
Does your child have any allergies?.........................................................
Are there any medical conditions we should be aware of?.....................................................................
Emergency Contact Names & Numbers
/....
Home address
.

Medical Emergencies
In the event of an emergency, we will make every possible effort to contact parents so that prior
consent can be obtained for your child to receive emergency medical treatment as considered
necessary by the medical authorities.
In case we cannot contact you and need to act promptly, please sign to give your consent for
emergency medical treatment including anaesthetic, if necessary.
I / We give consent to our son / daughter receiving emergency medical treatment.
Signed:. Parent/carer
Date

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