FOR VIEWING ONLY – to complete – Download either the Word or PDF Version

Parental Consent Form

I give consent for my child  …………………………………………………………. ( child #1 )

and                                     …………………………………………………( child #2 – optional)

to accompany ……………………………………………………………. (name of adult #1 in loco parentis)

and                 ……………………………………………………………. (name of adult #2 in loco parentis – optional )

to The George Starkey Hut

from (dates) ……………………………………. to ………………………….

I have been informed about the nature of the accommodation and the likely sleeping arrangements.  I understand that huts may have communal facilities, which include communal sleeping arrangements.

I understand that the above adult will endeavour to ensure that appropriate sleeping accommodation will be arranged for my child, with regard to age and sex and with regard to the needs of other members present

In the event of illness or an accident requiring emergency hospital treatment, I authorise the adult named on this form to sign on my behalf any written form of consent required by the hospital authorities, if the delay required to obtain my own signature is considered inadvisable by the doctor or surgeon concerned.

Signed (parent)  ………………………………………………….     Date ………………..   

Name (print)       …..………………………………………

Address ……………………………………………………………………………………………

Mobile #1 …………………………………………….

Phone  #2 (optional)  ………………………..

Once completed, and before the child visits The George Starkey Hut

The parent(s) need to provide copies to:

• the adult in loco parentis named above
• email a copy to george.starkey.hut@gmail.com