Holiday Travel Consent Form printable pdf download

Holiday Travel Consent Form (to be completed by a parent/legal guardian of The Child)

Child’s full name: __________________________________________________________ Date of birth _________________

Passport number:_____________________________

Valid until (date): ____________________

I, ________________________________________________________________________, am a parent/legal guardian of The Child

Address___________________________________________________________________________________________________

Telephone number _____________________________mobile__________________________Email ________________________

The Child has my consent to travel with Holiday Leaders:

Hugh Hunt (passport number 301011030) and Beatrice Hunt (passport number 04AE15935)

Mobile: 00 44 7779 653067

Mobile 00 44 7792 508597

to stay at 6 La Rayrie (near Gavray) Normandy, 50450, France (Tel: 00 33 2 33 50 11 70)

during the period of____________________________________________________________.

Health Information

EHIC (European Health Insurance Card) number

Travel Insurance details

The Child may swim under supervision..

Yes/No

Date of last Tetanus injection

The Child may swim unattended.

Yes/No

The Child may swim in the sea.

Yes/No

Family Doctor’s Name, Address and phone

Please list here:

1. any known Infectious Diseases with which the Child has been in contact within the last three weeks (e.g. Chicken Pox,

Diphtheria, Measles, Mumps, Rubella, Whooping Cough etc.)

2. Any Known Allergies/Sensitivities/Disabilities and details of any known precautions or remedies (e.g. Penicillin, Food

Colourings, Travel Sickness, Bed-wetting, Asthma etc.)

3. Details of any Medicines/Diets/Treatments currently being Taken/Followed (including dosage details) & the Specialist and

Hospital concerned if appropriate.

If it becomes necessary for The Child to receive medical treatment I give my general consent to any necessary medical treatment and

authorise either of the Holiday Leaders to sign any document required by the hospital authorities.

Declaration – signature of parent/legal guardian

I give permission for The Child to attend the Holiday. During this period I can be contacted at the address given above

Signature:__________________________________________________________________ Date:_________________

Holiday Travel Consent Form