NIPA Event Medical Needs Acknowledgement Form

Child’s Full Name:

First

Last

Class:

Does your child have any medical needs?

Please describe your child’s medical condition(s):

What medication does your child require during the event, if any?

(Please note: NIPA volunteers cannot administer medication but may assist in accessing it if appropriate.)

Where is this medication stored during the school day?

(e.g. in classroom, school office, pupil’s bag)

What should we do in the event of a medical concern?

(Brief step-by-step or notes – e.g. use inhaler, call parent, etc.)

Please read and confirm the following:

I understand that the event is organised by NIPA, a parent-led voluntary group, and is not a school-led activity.
I understand that NIPA volunteers may not have medical training or access to pupil medical records.
I understand that I remain responsible for ensuring that any essential medical information or instructions are clearly shared with NIPA in advance of the event.
I give permission for basic first aid to be administered if required, and for NIPA or the school to contact me in the event of a concern.
I agree that if the nature of my child's medical condition requires a trained person, I must attend the event too.

I confirm that I understand and agree with the above.

Parent/Carer Name:

First

Last

above. the any

Relationship to Child:

Emergency Contact Number (during event time):

Email Address (optional):

I confirm that the information provided is accurate and up to date. I will inform NIPA of any changes before future events.