PARENT/GUARDIAN CONSENT FORM FOR

OUT-OF-CAMPUS ACTIVITY

I/We agree to my son/daughter: Student Name _____________________________________ Student

ID Number _______________ participating in the out-of-campus activity described below.

Programme: FIST JAN/MAR 2018

Activity Description: Yakult Factory, Field Trip
Date and Time: 2nd July, 2018
8.00am – 2.00pm
Supervising Programme Member: Ms. Yuvarani Nair Sukumaran
Ms. Cass Goh

I acknowledge the need for responsible behaviour on his/her part.

_______________________________________ _________________________
Signature of Parent/Guardian Date

MEDICAL INFORMATION

This is included to assist college-designated personnel in assuring your child’s well being. Please list
seizures, diabetes, muscular or skeletal problems, or any other medical condition you would like called
to the college’s attention.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

In an emergency, I can be contacted at the following details:

Name:

House Address: __________________________________________________________________

__________________________________________________________________

Mobile Phone: __________________________________________________________________

In the unlikely event of an accident or illness during the event which needs immediate medical treatment,
I agree to my son/daughter receiving first aid and medical treatment from qualified practitioners, as may
be considered necessary by a medical doctor/nurse.

Signature ________________________________________ Date ______________________