Holiday Travel Consent Form


Holiday Travel Consent Form (to be completed by a parent/legal guardian of The Child)
Child’s full name: __________________________________________________________ Date of birth _________________
Passport number:_____________________________
Valid until (date): ____________________
I, ________________________________________________________________________, am a parent/legal guardian of The Child
Telephone number _____________________________mobile__________________________Email ________________________
The Child has my consent to travel with Holiday Leaders:
Hugh Hunt (passport number 301011030) and Beatrice Hunt (passport number 04AE15935)
Mobile: 00 44 7779 653067
Mobile 00 44 7792 508597
to stay at 6 La Rayrie (near Gavray) Normandy, 50450, France (Tel: 00 33 2 33 50 11 70)
during the period of____________________________________________________________.
Health Information
EHIC (European Health Insurance Card) number
Travel Insurance details
The Child may swim under supervision..
Date of last Tetanus injection
The Child may swim unattended.
The Child may swim in the sea.
Family Doctor’s Name, Address and phone
Please list here:
1. any known Infectious Diseases with which the Child has been in contact within the last three weeks (e.g. Chicken Pox,
Diphtheria, Measles, Mumps, Rubella, Whooping Cough etc.)
2. Any Known Allergies/Sensitivities/Disabilities and details of any known precautions or remedies (e.g. Penicillin, Food
Colourings, Travel Sickness, Bed-wetting, Asthma etc.)
3. Details of any Medicines/Diets/Treatments currently being Taken/Followed (including dosage details) & the Specialist and
Hospital concerned if appropriate.
If it becomes necessary for The Child to receive medical treatment I give my general consent to any necessary medical treatment and
authorise either of the Holiday Leaders to sign any document required by the hospital authorities.
Declaration – signature of parent/legal guardian
I give permission for The Child to attend the Holiday. During this period I can be contacted at the address given above
Signature:__________________________________________________________________ Date:_________________


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