Parental Consent for Stay

Parental Consent for Stay
Please complete this form to provide parental authorization for your child to participate in an overnight stay or similar activity.
Child's Full Name
First NameLast Name
Child's Date of Birth
MonthDayYear
Date
Name of Parent or Legal Guardian
First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Address of Parent/Guardian
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Destination or Location of Stay
Purpose of Stay (e.g., school trip, camp, friend’s house)
Dates of Stay (Start and End)
MonthDayYear
Date
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have any allergies, medical conditions, or special needs?
If yes, please provide details about any allergies, medical conditions, or special needs.
Parent/Guardian Signature
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