MALAYSIAN EXPEDITION 2011   

 

I______________________parent of______________________________

have read the details of the Malaysian Expedition. I give permission for my daughter/son to take part and, in the event of an emergency, I also consent to his/her receiving emergency medical or dental treatment, including anaesthetic or blood transfusion, as considered necessary by medical authorities.

I confirm that the medical and emergency details provided to the Academy are correct and up-to-date. (Please note that if your child has a history of asthma or ear trouble, it is worth consulting with your doctor.)

 

Pupil Form Class ______________    Pupil Date of Birth ________________

 

Pupil Passport Number__________________________________________
(must be valid to January of year following trip.)

 

Contact telephone number ______________________________________

 

Please indicate any dietary requirements here:

 

 

 

 

 

 

Please indicate any previous diving experience/qualification here:

 

 

 

 

 

 

Signed: _____________________________ Date:___________________