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Parental Consent Form Template
Get clear written permission from a parent or guardian for a minor’s activity or care with this Parental Consent Form Template.
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Parental Consent Form Template
This Parental Consent Form (the “Form”) is completed by the undersigned parent/legal guardian as of [Date].
1. Minor Information
1.1 Minor Full Name. [Child’s full legal name].
1.2 Date of Birth. [DOB].
1.3 Home Address. [Address].
1.4 School/Organization (Optional). [Name].
2. Parent/Guardian Information
2.1 Parent/Guardian Name. [Full name].
2.2 Relationship to Minor. ☐ Parent ☐ Legal guardian ☐ Other: [Relationship].
2.3 Phone Number. [Phone].
2.4 Email Address. [Email].
2.5 Address (If Different). [Address].
2.6 Second Parent/Guardian (Optional). [Name/Phone/Email].
3. Activity or Service Details
3.1 Activity/Service Name. [Name].
3.2 Description. [Brief description].
3.3 Dates and Times. [Dates/times].
3.4 Location. [Address/location].
3.5 Supervising Organization/Provider. [Name].
3.6 Supervisor/Leader Contact (Optional). [Name/Phone].
4. Consent and Permissions
4.1 Participation Consent. I give permission for the Minor to participate in the activity/service described in Section 3.
4.2 Transportation Consent (Optional). ☐ Yes ☐ No. If yes: transportation method: [Bus/Carpool/Other].
4.3 Media Release (Optional).
☐ I consent to photos/video/audio recordings of the Minor for: ☐ Internal use ☐ Public promotional use
☐ I do not consent to photos/video/audio recordings
4.4 Off-Site Activities (Optional). ☐ Allowed ☐ Not allowed.
5. Emergency Contact and Medical Information
5.1 Emergency Contact Name. [Name].
5.2 Emergency Contact Phone. [Phone].
5.3 Allergies/Medical Conditions (Optional). [Details].
5.4 Medications (Optional). [Details].
5.5 Primary Physician (Optional). [Name/Phone].
5.6 Health Insurance (Optional). Provider: [Name], Policy #: [Number].
6. Emergency Medical Authorization (Optional)
6.1 Authorization. In the event of an emergency and if I cannot be reached, I authorize the supervising organization/provider to obtain emergency medical evaluation and treatment for the Minor, as recommended by a licensed medical provider.
6.2 Limitations. This authorization is limited to emergency care and does not include non-emergency procedures unless required to prevent serious harm.
7. Acknowledgments
7.1 Accuracy. I confirm the information provided is accurate to the best of my knowledge.
7.2 No Guarantee of Safety. I understand that participation may involve risks and that the supervising organization will take reasonable precautions, but cannot guarantee safety.
7.3 Revocation. I may revoke this consent in writing, but revocation may not affect activities already scheduled or underway.
Signatures
By signing below, the undersigned parent/legal guardian grants the permissions described in this Form.
Parent/Guardian Name: [Name]
Date: [Date]
Signature: ___________________________
Second Parent/Guardian (Optional): [Name]
Date: [Date]
Signature: ___________________________
Organization/Provider Representative (Optional): [Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________
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Parental Consent Form Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
PARENTAL CONSENT FORM TEMPLATE FAQ
What is a parental consent form?
A Parental Consent Form is a written document where a parent or legal guardian gives permission for a minor to participate in an activity or receive a service. It helps schools, camps, clubs, and service providers document consent and emergency contact details.
When should you use a parental consent form?
Use it anytime a minor needs an adult’s permission — such as field trips, sports, tutoring, online programs, photos/videos, medical treatment authorization (limited), or travel. It’s especially important when the child will be supervised by others or participating off-site.
What should be included in a parental consent form?
Common sections include the child’s name and date of birth, parent/guardian contact information, the activity description, dates and location, supervision details, emergency contacts, medical or allergy notes, permissions granted, and the parent/guardian signature.
Does this form authorize medical treatment?
It can authorize limited emergency care, but rules vary by jurisdiction and provider. If you need broader medical authorization (especially for travel), you may need a separate medical consent form or notarized authorization. This template includes an optional emergency care clause.
Can a parental consent form include photo/video permission?
Yes. Many organizations include a media release clause to allow photos or recordings for newsletters, social media, or marketing. This template includes an optional section you can include or remove.
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