/Templates/Parental Consent Form Template

Parental Consent & Release Form

Use this parental consent form to collect permission from parents for activities involving children, covering safety information and emergency contacts. You can personalize this form with your organization's logo and branding colors.

Your child has been invited to participate in [activity or program name] taking place on [date] at [location]. It will involve [brief description of activities].

Please fill out this form to provide consent if you would like your child to participate.

Child Information

Child's full nameRequired

Date of birthRequired

AgeRequired

GenderRequired

Parent/Guardian Information

Parent/Guardian full nameRequired

Relationship to childRequired

Phone numberRequired

Email addressRequired

AddressRequired

Emergency contact if different from above

Emergency contact phone number

Medical Information

Does your child have any allergies?Required

AYes

BNo

Does your child have any medical conditions we should know about?Required

AYes

BNo

Any special instructions or requirements?

Consent and Release

Please check all boxes to provide your consent:

I am the parent/legal guardian of the child named above.Required

I give permission for my child to participate in the activity(-ies) described above.Required

I understand the nature of the activity(-ies) and any associated risks.Required

I give permission for emergency medical treatment if necessary.Required

I agree to be responsible for any medical expenses incurred.Required

I release the organizer from liability for injury or loss during participation.Required

Parent/Guardian signatureRequired

Draw your signature here

DateRequired