Germany Tour 2023 - Information form Step 1 of 4 25% Student detailsStudent Name(Required) Prefix Dr.MissMasterMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Student's Date of Birth(Required) DD slash MM slash YYYY Passport informationPassport Number Country of Issue Date of Issue Day Month Year Expiry date Day Month Year Please attach scan / image of your child's passport.Max. file size: 32 MB.Global Health Insurance Card (GHIC) Number Please input the long 20 digit number. If you haven't got a Global Health Insurance Card please apply via: https://www.gov.uk/global-health-insurance-cardGHIC Expiry Date Day Month Year Please attach scan / image of your child's GHIC Card.Max. file size: 32 MB. Parent/Carer DetailsName(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Last Mobile Phone number(Required)Additional emergency contact number(Required)Home Phone numberWork Phone numberContact information(Required) I confirm that to the best of my knowledge all contact information provided is correct. I confirm that I will notify West Sussex Music with any changes to my contact information.Photo of my child(Required)Max. file size: 32 MB.Please attach an image to clearly identify your child in the event of an emergency. Photo consent Photo/video permissions (I agree to photographs and videos being taken that include my child. I understand that these pictures may be used for normal publicity purposes - including publication on the establishment's website and social media platforms.) Medical / Pastoral informationDoes student have any medical or mental health conditions / dietary requirements / special educational or pastoral needs?(Required) Yes No Name of condition / needs Describe medical/pastoral needs?Give details of child's symptoms, triggers, signs of illness, treatments, daily care requirements, environmental issues etc.Name of Medicine (as described on the container)Medication expiry date DD slash MM slash YYYY Name of GP & Surgery (please give if relevant)Name of Hospital (please give if relevant)Dosage, Method & FrequencyPlease give details of how much should be given, how often and how the medicine should be administered.Are there any side effects / additional information we may need to be aware of?Can student administer their own medication?Please selectYesNoAny further information it would be helpful for us to know?:Medication Permission I recognise that West Sussex Music cannot take any responsibility if my son/daughter does not explain, when asked, if she/he has taken any tablets/medication prior to this request. This permission will take effect when my child has checked in on the coach until they leave the coach at the end of the trip. All medication will be given as per the packaging/instructions provided and a record will be kept in the medication log. Instrument detailsMy child will be bringing an instrument. Yes No InstrumentViolinViolaCelloDouble BassPiccoloFluteOboeClarinetBass ClarinetBassoonFrench HornTrumpetTromboneTubaOtherInstrument Make Instrument Model Instrument Serial Number Replacement Cost Other instrument detailsConsent Whilst every effort will be made to handle my child's instrument with the utmost care, I accept that West Sussex Music cannot be held responsible for any damages that occur and my child's instrument should be adequately covered by my own insurance.Insurance documents Drop files here or Select files Max. file size: 32 MB. PrivacyConsent I accept that the information provided on this form may need to be shared with relevant persons involved in the trip.Consent I agree to the privacy policy. (https://www.westsussexmusic.co.uk/privacy-notice/) Δ
