Legal & declarations
Guardian consent template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
Fill in this template- Written for US law, with your state left to fill in
- Fill the blanks in your browser
- Print, or save as PDF or Word
- No account needed to start
Preview — US standard
Parent or Guardian Consent Form
Child's Information
Child's name: Child Full Name
Date of birth: Child Date of Birth
Parent or Legal Guardian
Name: Parent or Guardian Name
Relationship to child: Relationship
Address: Parent or Guardian Address
Phone: Parent or Guardian Phone
Email: Parent or Guardian Email
Activity
I give permission for my child to take part in: Activity, Trip or Program
Organized by: Organization Name
Date(s): Activity Dates
Location: Activity Location
Supervising adult(s): Supervisor Names
Transportation: Transportation Arrangements
Emergency Contact
If I cannot be reached: Emergency Contact Name, Relationship and Phone
Health Information
Allergies: Allergies or None
Medications and when given: Medications or None
Medical conditions the supervisors should know about: Conditions or None
Health insurance: Insurer and Policy Number
Emergency Medical Treatment
If my child needs emergency medical care and I cannot be reached, I authorize the supervising adults to seek treatment from licensed medical providers, and I authorize those providers to give the treatment they consider necessary. I will be responsible for the cost of that treatment.
Photos
Photo permission: I Agree or I Do Not Agree that photos or video of my child taken during the activity may be used by the organizer for Permitted Uses.
Acknowledgment
I have read the description of the activity and understand its nature. I confirm that I am the child's parent or legal guardian with authority to sign this form. This consent is valid from Start Date to End Date, unless I cancel it in writing.
Parent or guardian signature: Parent or Guardian Signature
Printed name: Parent or Guardian Printed Name
Date: Signing Date