Guardian Consent Form Template

Activities that involve a child need a guardian's yes on record. This form collects the child, the activity, an emergency contact, and a signature.

Great for

• Schools collecting consent for an activity
• Clubs and camps that need a guardian signature
• Clinics confirming a guardian agrees to a visit

Name the activity in the question so the guardian knows what they are agreeing to.

Keep medical notes short. A full health history belongs in your usual intake, not this consent.

Questions in this template

1. Guardian name *
   Name
2. Email *
   Email
3. Phone *
   Phone
4. Child's name *
   Name
5. Activity or program *
   Short text
6. I consent for this child to take part *
   Yes or no
7. Emergency contact name and phone *
   Short text
8. Medical notes or allergies
   Long text
9. Guardian signature *
   Signature