Extra information for camp attendees

Child's name *

If you need to give us information for more than one child, please complete a separate form.

Date of birth *

Does your child have:

Allergies
Asthma
Other medical conditions
SEN
Disability, accessibility or care needs

Please tick all that apply

GP name/surgery

About your child’s allergies

What are they allergic to?

Please include details of whether they are affected by eating, touching, airborne etc.

Please describe symptoms of their allergic reaction

Has your child be prescribed an adrenaline auto-injector (Epipen, Jextpen or similar)? *

support a their

Has your child ever needed to use their Epipen? *

Standard emergency procedure in case of severe allergic reaction:

•      Call an ambulance (while another member of staff administers first aid)
•      Administer adrenaline auto-injector (or help child to administer if able)
•      Treat for shock if necessary

Do you consent to this treatment being given in an emergency? If not, please give alternative instructions.

Standard procedure *

Please give alternative instructions *

Please give details of any other medications which may be needed during camp

Include dose, times etc. By entering this information you give consent for staff to administer them as per your instructions.

About your child’s asthma

Does their asthma have a specific triggers?

Have they been prescribed an inhaler for use during the day?

Please provide instructions for inhaler use *

Include type of inhaler, how many puffs, do they have a spacer.

Can they administer their own inhaler?

By themself
With help from an adult
Adult to administer

Standard emergency procedure in case of a asthma attack:

• Give 6 puffs of the blue inhaler via a spacer (if provided)
• Reassess after 5 minutes
• If the child still feels wheezy or appears to be breathless they should have a further 4 puffs of the blue inhaler

Reassess after 5 minutes
• If their symptoms are not relieved with 10 puffs of blue inhaler then this should be viewed as a serious attack:
• CALL AN AMBULANCE and CALL PARENT
• While waiting for an ambulance continue to give 10 puffs of the reliever inhaler every few minutes

Do you give consent for this treatment in case of an emergency? If not, please give alternative instructions.

Standard procedure *

Please give alternative instructions *

About your child’s medical condition(s)

Please describe your child's medical condition(s) *

Other than allergies or asthma already described

Please describe any symptoms and action required *

Include any other information that may be helpful

Are there any activities that should be avoided? *

Does your child require any prescribed medication while at camp? *

Please give details including doses and times.

About your child’s additional needs

We want to make sure all of our young scientists get the most out of the day. So any information that you can give us is really helpful in making sure we can support your child at camp.

Please tell us:

What do they like?
What do they find tricky?
Is there anything that makes them anxious?
What helps them if they feel overwhelmed?
Any top tips to help them enjoy the day?

Type of SEN

How can we support your child?

About your child’s accessibility needs

We want to make sure all of our young scientists get the most out of the day. So any information that you can give us is really helpful in making sure we can support your child at camp.

Please tell us:

Any accessiblity concerns that we need to check with the venue
Anything that they might need support with
How they would like us to support them
Anything that should be avoided
Anything else that you think we should know!

Please outline accessibility/care needs

How can we support your child?

Your name *

Your relationship to child *

Your email address *

Please note that this form is only for providing extra information if requested (when you have already booked your child into a camp).

If you would like to make a new booking, you can find online registration here.

About your child’s allergies

About your child’s asthma

About your child’s medical condition(s)

About your child’s additional needs

About your child’s accessibility needs

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