The parent or guardian giving consent
Only someone with parental responsibility can sign this form
Your current residential address
So you can be reached in an emergency
As it appears on official documents
Date of birth for identification
Leave blank if same as your address
Medical records and GP information
The person who will be caring for your child
Select the most appropriate option
Address and phone number
Food, medication, or environmental allergies
Asthma, diabetes, epilepsy, etc.
Prescribed or over-the-counter medicines
According to the NHS vaccination schedule
Medical, religious, or ethical restrictions
Select the scope of treatment allowed
Specific treatments you do NOT authorise
Choose the validity period
First person to call in an emergency
Second person to call if primary unavailable
Anything else caregivers or medical staff should know
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