Parent Consent Form
Title of Event: Year 10 French trip on 13th June, 2025
The Educational purpose of the programme: To give students practical exposure to the
French language and enable students to interact with French resources and materials from the
State-of-the-Art Multimedia Library.
Details of supervising staff: Two teachers (1 male and 1 female teacher) will be available to
care for the learners’ needs.
Name and contact details of the 24-hour school emergency contact:
Please contact the School Admin Office on, (254-20) 2084267/2084270 or Mobile: (254) 723
318833
Pupil behaviour
‘I understand that in the event of my son’s/daughter’s misbehaviour or behaviour that poses a
danger to himself/herself or others during the trip, he/she may be sent home. I further
understand that in such circumstances I will be informed and that any costs associated with
his/her return will be my responsibility.’
ICT/Photograph consent
‘I consent to my child being photographed and/or visual images of my child being taken
during activities by the school for use in the school’s publications, school’s website or for
publicity purposes without acknowledgement and without being entitled to any remuneration
or compensation.’ [Strike out if you do not consent]
Consent for emergency transportation
‘In the event of an emergency I consent to my child being transported in an ambulance, SCS
International owned vehicle or company-owned vehicle (if necessary).’
Pupil accident insurance
All pupils are covered under Heritage Insurance Co. Ltd for injuries resulting from accidents
whilst on the trip. This does not cover emergency evacuation or sickness.
Parent Consent
I have read all of the above information provided by the school in relation to the Year 10 French Trip to
Alliance Francaise, including any attached material.
I give permission for my daughter/son_______________________________________
Jackline Ajak (full name) to
attend.
Parent/guardian: _______________________________________
Achieng Ring (print full name)
_______________________________________ (signature) ____________
11/9/25 (date)
In case of emergency, I can be contacted on: ____________________________
0796778886 OR:
____________________________
Confidential Medical Information for School Trips/sleepover
The school will use this information if your child is involved in a medical emergency. All
information is held in confidence. The medical information on this form must be current
when the trip is run. In the event of any accidental injury, parents are responsible for all
medical costs.
Excursion/programme/Trip name: French Trip to Alliance Francaise De Nairobi
Date(s): 13/06/2025
Pupil’s full name: Jackline Ajak Athuai Ayuel
Pupil’s address: Young Gardens Apartments Riara Ln
Postcode:
Date of birth: 13-4-11 Form
Parent/guardian’s full name: Achieng Ring
Emergency telephone numbers: After hours 0796778886 Business hours
Name of person to contact in an emergency (if different from the parent/guardian):
Emergency telephone numbers: After hours Business hours
Name of family doctor: Dr. Adwok
Address of family doctor: Karen
Phone number: 0722511134
Private Medical Insurance Provider & Contact Number:
Member number:
Please tick if your child is living with any of the following health conditions (if you have
ticked any of the boxes, please provide medical plan details in the ‘other’ section:
♦ Asthma
♦ Anaphylaxis
♦ Epilepsy
♦ Blackouts
♦ Diabetes
♦ Dizzy spells
♦ Migraine
♦ Heart condition
♦ Sleepwalking
♦ Travel sickness
♦ Fits of any type
♦ Other:
Allergies
Please tick if your child is allergic to any of the following:
Note: All catering provided by SCS International will be taken from the School ‘Specials’ list
– if this needs updating, please notify the catering department.
♦ Penicillin
♦ Other Drugs:
♦ Foods:
♦ Other allergies:
What special care is recommended for these allergies?
Year of last tetanus immunisation: (Tetanus immunisation is normally given at five years of
age (as Triple Antigen or CDT) and at fifteen years of age (as
ADT))…………………………………………………………………………………………
………….
Medication
Is your child taking any medicine(s)? ♦ Yes ♦ No
If yes, provide the name of medication, dose and describe when and how it is to be taken.
All medication must be given to the Nurse. All containers must be labelled with your child’s
name, the dose to be taken as well as when and how it should be taken. The medications will
be kept by the staff and distributed as required. Inform the teacher organizing the trip or
school nurse if it is necessary or appropriate for your child to carry their medication (for
example, asthma puffers or insulin for diabetes). A child can only carry medication with the
knowledge and approval of both the teachers on board and school nurse.
Medical consent
Where the Boarding tutors are unable to contact me, or it is otherwise impracticable to
contact me, I authorize the boarding tutors to:
€ Consent to my child receiving any medical or surgical attention deemed necessary by a
medical practitioner.
€ Administer such first-aid as the teacher-in-charge judges to be reasonably necessary.
Signature of parent/guardian (named above)
Date:
Mary Ndungi
French Teacher
Ngong Road, Karen
P.O Box 21378 – 00500 Nairobi.
Mobile :( 254)723318833
info@[Link]
