Consent for Emergency Medical or Dental Treatment

This form is in anticipation of the extremely rare event in which your child is seriously hurt and we are unable to contact anyone with parental responsibility.

You can see our full Medical Care Policy on the policies page 

Please complete all fields marked (*)

Your first name *

Your last name *

Do you consent for your child to receive urgent medial or dental treatment? *

This includes the administration of general anaesthetic and to surgical operations in the case of emergency in accordance with the recommendation of a qualified medical practitioner

Yes No

Child's full name *

Year that the child started school *

Relationship to child

Please provide a signature. *