1. education
2. school

25th February 2015
Dear Parents and Carers
Visit to Coombes Farm, Lancing – Thursday 12th March 2015
As part of our new topic, Our Wonderful World, we are pleased to notify you that we have booked an exciting trip to
Coombes Farm. This is a real working farm, where children will have the opportunity to see lambs being born and see
lots of farm machinery in action!
Your child will need to bring warm and waterproof clothing and wellies or other appropriate footwear, plus inhalers if
your child requires one. It is likely to be very muddy and we hope to go whatever the weather! If your child usually has
hot dinners, a packed lunch will be provided for them by Zebedees but you are welcome to give your child an extra
snack and drink if you wish.
In order for the trip to go ahead, we will need four parent helpers per class. If you have a valid DBS certificate (formerly
CRB) and would like to help, please indicate this on the slip below and speak to your child’s class teacher.
We are asking parents to pay a voluntary contribution of £11.20 to cover the cost of the trip including coach travel. This
can be paid either online via School Gateway or by cash/cheque to the school office (please make cheques payable to River
Beach Primary School). We must inform you that if insufficient monies are received, the trip may have to be cancelled.
Please fill in the permission slip below and indicate your preferred method of payment. Please also complete the
attached parental consent form and medical questionnaire. Please return all forms and money to school by Thursday 5th
March, thank you.
We will need to leave promptly at 9:00am and will be back by the normal end of school day time, 2:50pm.
If you have any further questions, please speak to your child’s class teacher.
Yours sincerely
The Reception Team

th
Please return this form to your child’s class teacher or the school office by Thursday 5 March, thank you.
Visit to Coombes Farm, Lancing – Thursday 12th March 2015
I give permission for (name of child) ......................................................................................... in class …................................
to visit Coombes Farm.
 I will make payment of £11.20 via School Gateway
or
 I enclose £11.20 cash/cheque.
 I have enclosed and completed the attached Parental Consent and Medical Questionnaire.
 I am able to help on the trip and have a current DBS certificate. Please contact me on the no. below:
Contact name .................................................................. Contact no ………………………………………………
Signed............................................................................... Date .........................................
APPENDIX A
PARENT’S CONSENT FORM
RIVER BEACH PRIMARY SCHOOL
________________________________________________________________________________________
Coombes Farm, Lancing
A journey to ________________________________________________________________________
(place)
th
th
12 March 2015
12 March 2015
from ___________________________________
(date) to __________________________________
(date)
I wish my son/daughter ______________________________________________________ (Full name of child
in capitals please)
to be allowed to take part in the above-mentioned school (or youth centre) journey and, having read the
information sheet, agree to his/her taking part in any or all of the activities described.
I have ensured that my child understands that it is important for his/her safety and for the safety of the group
that any rules and any instructions given by the staff in charge are obeyed.
I understand that, while the school staff and helpers in charge of the party will take all reasonable care of the
young people, unless they are negligent they cannot be held responsible for any loss, damage or injury
suffered by my son, daughter arising during or out of the journey.
(Note: A School Journey Insurance Policy of Zurich Municipal Insurance Limited is available through West
Sussex County Council, though claims arising from a pre-existing condition are exempt.)
Date of Birth:
Please delete and complete the following as is appropriate.
My child has
no illness, allergy or physical disability
the following illness, allergy or physical disability
/
/
Name of own Doctor:
*
*
Doctor’s Address:
Doctor’s telephone number:
* Cross out which does not apply
___________________________________________________
necessitates the following medical treatment
___________________________________________________
________________________________________________________________________________________
I consent to any emergency medical treatment necessary during the course of the visit.
Signed ______________________________________________
Parent/Guardian
Address
HOME
WORK
Telephone No.
HOME
WORK
Date _____________________
Mobile No.
If not available at the above, please state an alternative contact.
Name:
____________________________________________________
Telephone No:
______________________________ Mobile No: ______________________________
(Three copies of this form are desirable, one for the parent to keep, one for the head of establishment/EVC/ Emergency
Contact and one for the group leader to take with him/her on the visit/activity/journey.
NOTE: Photographs may be taken that include your son/daughter. If you do not wish such pictures to be
used for normal publicity purposes including publication on the establishment’s website please tick box:
All personal information will be processed in accordance with the provisions of the Data Protection Act 1998

APPENDIX B Guidance on information you may wish to acquire in confidence:-
MEDICAL QUESTIONNAIRE
PUPIL’S NAME
____________________________________________________________
PARENT’S NAME AND INITIALS ____________________________________________________________
HOME ADDRESS
____________________________________________________________
____________________________________________________________
TELEPHONE NO. ___________
____________________________________________________________
NAME AND ADDRESS OF
____________________________________________________________
FAMILY DOCTOR
____________________________________________________________
____________________________________________________________
TELEPHONE NO.___________
____________________________________________________________
DIETARY REQUIREMENTS
____________________________________________________________
Has your child had any of the following:Asthma or Bronchitis
Heart condition
Fits, fainting or blackouts
Severe headaches
Diabetes
Allergies to any known drugs or medication
Any other allergies e.g. material, food, insect bites etc.
Other illness or disability
Any recent contact with contagious diseases and infections
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
If the answer to any of these questions is YES please give details on a separate sheet which should be firmly
attached:
________________________________________________________________________________________
Immunisation Status
Has your child received vaccination against
Tetanus in the last ten years?
YES
NO
________________________________________________________________________________________
Is your child receiving medical treatment of any
kind from either your Family Doctor or Hospital?
YES
NO
Has your child been given specific medical advice
to follow in emergencies?
YES
NO
If the answer to either of these questions is YES please give the details here:- (including dosage of any
medicines/tablets)
________________________________________________________________________________________
SIGNED
______________________________________________________Parent/Guardian