MALAYSIAN EXPEDITION     2009    2010    [Circle the year of your choice]

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: ______________________