Parent'S Consent Form printable pdf download

PARENT’S CONSENT FORM

Appendix D

School (or Youth Centre): ________________________________________________________________

A journey to ______________________________________________________________________ (place)

from __________________________________ (date)

to _______________________________ (date)

I wish my son/daughter ______________________________________________________ (name of child)

to be allowed to take part in the above-mentioned school (or youth centre) journey and, having read the

information sheet, agree to his/her taking part in any or all of the activities described.

I have ensured that my child understands that it is important for his/her safety and for the safety of the

group that any rules and any instructions given by the staff in charge are obeyed. I acknowledge the need

for my child to behave responsibly.

Please delete and complete the following as is appropriate:

My child has

no illness, allergy or physical disability

the following illness or physical disability

*Cross out which does not apply

______________________________________________________________________________________

which necessitates the following medical treatment _____________________________________________

______________________________________________________________________________________

I consent to any emergency medical treatment necessary during the course of the visit.

I consent/do not consent* to my son/daughter being given a mild painkiller (paracetamol) if considered

necessary by the party leader.

*Delete as applicable

Signed: _____________________________________________ (Parent/Guardian)

ADDRESS

HOME

WORK

_____________________________

_______________________________

_____________________________

_______________________________

_____________________________

_______________________________

Tel No: HOME _____________________________

WORK _________________________

If not available at the above, please state an alternative contact

Name: __________________________________

Tel No: _________________________

(Three copies of this form are desirable – one for the parent to keep, one for the Duty Officer and one for

the Party Leader to take with him/her on the visit/activity/journey)

X:\Development Office\School Information\Website\Parent's Consent Form.doc

Parent'S Consent Form