A number of families were lucky enough to get places on the Santa Express this year 2013. Below is the report of one of them.
We have been asked by Crumlin to publicize this event.
If you do go on this event we would love to hear how you get on.
Our Lady’s Children’s Hospital is the beneficiary of a 70-90 minute flight across Ireland for the children of the hospital to try and find Santa Clause!. This event is scheduled to take place on Saturday evening 7th December 2013. The number of seats is limited. Parents/guardians are advised to complete the ‘Nomination/Consent form’ & return it to the address provided on the form as soon as possible (Closing date for return of forms is Thursday 7th November 2013). Please review details below about this special event!!
SATURDAY 7th DECEMBER 2013
The trip is for 1 child & 1 guardian. Each child must be accompanied by an adult guardian.
The trip will commence from Our Lady’s Children’s Hospital (OLCHC) and all those travelling will be asked to come to OLCHC that afternoon for a small party and to register for the trip.
Please note times are subject to change and will be confirmed nearer the date. See Terms & Conditions overleaf.
OFFICE OF THE DIRECTOR OF NURSING June Farrell-Biggs, Tel: 01 409 6308
Terms & Conditions
Should you wish to nominate your child, please note the following Terms & Conditions.
Please see the Nomination/Consent form. This form must be signed by a parent/legal guardian and returned to the address provided on or before Thursday 7th November 2013. Your signature on this form signifies that you agree to the following terms and conditions.
June Farrell-Biggs, Office of the Director of Nursing Telephone: 01 409 6308
PATIENT EVENT NOMINATION &
MEDIA CONSENT FORM
Saturday 7th December 2013
This event is subject to availability as places are limited. Completion of this form does not signify a place on this event. All places for this event will be verified by contact from the hospital (written confirmation notice), in advance of the event date. Thank you.
Please use BLOCK capitals
1. Patient Name: (First name)____________________________ Surname:_____________________Age:____
2. Parent / Guardian: (First name)_________________________ Surname:_____________________
Contact Telephone No.____- ________________________ Mobile No: __________-________________
Brief summary of patient’s condition:_______________________________________________________
If Inpatient, Consultant signature: _________________________________ Date: _________________
Special Dietary Requirements: Yes ¨ No ¨ (please tick)
If yes, please state what food is required:_______________________
Is patient diabetic: Yes ¨ No ¨ (please tick)
Mobility needs (e.g. wheelchair): Yes ¨ No ¨ (please tick) __________________________________
Parking required at hospital Yes ¨ No ¨ (please tick)
I/We the undersigned do hereby give permission for the above named patient to participate in this trip/event. This will also involve passing the names of those participating in this trip to the sponsor & Dublin Airport as part of travel/security protocols. We hereby agree to adhere to all safety & security guidelines as indicated by Dublin Airport.
I/We _________________________________ being the legal Guardians/Parents hereby consent to the participation of our said son/daughter in the above publicity event at/by Our Lady’s Children’s Hospital sponsored by a third party. I understand that this participation may include my child in a photograph, interview or film footage for the media or third party. It may also name my child as a patient of the hospital. I/We understand that Our Lady’s Children’s Hospital, Crumlin have no control over the circulation of any film footage/photography/interviews taken. I understand that any photographs/film footage/interviews taken may be used for the hospital website, promotional hospital material e.g. fundraising and presentations, other hospital and the above event’s website, media website and newsletters.
Signed: Parent/Guardian: ______________________________ Date: ___________________
Please return this form to June Farrell, Office of the Director of Nursing, Our Lady’s Children’s Hospital, Crumlin
before Thursday 7th November 2013. Telephone +353 1 4096308