Field Trip / Excursion Parental Consent Form

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Section 1: Organisation Details

Organisation Name: [ORGANISATION NAME] Fill in the full legal name of the school, sports club, or daycare.

Address: [ORGANISATION ADDRESS] Full postal address.

Main Contact Name: [CONTACT PERSON NAME] Main Contact Phone: [CONTACT PHONE] Main Contact Email: [CONTACT EMAIL]

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Section 2: Trip / Excursion Details

Trip / Excursion Name: [TRIP NAME] A short descriptive title, e.g. “Science Museum Day Trip” or “Regional Football Tournament”.

Destination: [DESTINATION NAME AND ADDRESS] Full name and address of the venue or location.

Purpose and Planned Activities: [TRIP PURPOSE AND ACTIVITIES] Describe what the child will do, e.g. “Guided museum tour, hands-on science workshops, outdoor picnic lunch.”

Date(s): [TRIP DATE(S)] Include all dates if the trip spans more than one day.

Departure Time: [DEPARTURE TIME] — Departure Point: [DEPARTURE LOCATION]

Expected Return Time: [RETURN TIME] — Return Point: [RETURN LOCATION]

Mode(s) of Transport: [TRANSPORT MODE(S)] E.g. “Chartered coach,” “Public train,” “Walking.” List all modes used.

Supervising Staff: [SUPERVISING STAFF NAMES OR SUPERVISION RATIO] List the names of lead staff/volunteers, or state the planned adult-to-child ratio. Note: minimum ratios vary; confirm with your local authority or governing body.

Known and Foreseeable Risks: [ACTIVITY-SPECIFIC RISKS] Be specific, e.g. “Travel by road; outdoor terrain with uneven surfaces; contact sport activities; exposure to unfamiliar animals.” Do not leave this blank — adequate risk disclosure is essential for informed consent.

Cost per Child: [COST AMOUNT AND CURRENCY] State the total cost payable by the parent, if any.

Refund Policy: [REFUND POLICY] E.g. “Full refund if withdrawal received in writing before [DATE]; no refund after that date.”

Insurance Statement: [INSURANCE COVERAGE STATEMENT] State what insurance, if any, covers participants during this trip, e.g. “Participants are covered under the organisation’s group liability and accident insurance policy.”

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Section 3: Child Details

Child’s Full Legal Name: [CHILD FULL NAME] As it appears on official documents.

Date of Birth: [CHILD DATE OF BIRTH] DD/MM/YYYY.

Age at Time of Trip: [CHILD AGE]

Class / Group / Team: [CHILD CLASS OR GROUP] E.g. “Year 5 Maple Class,” “U12 Blue Team,” “Nursery Room B.”

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Section 4: Emergency Contacts

Primary Emergency Contact

Full Name: [PRIMARY CONTACT NAME] Relationship to Child: [PRIMARY CONTACT RELATIONSHIP] Primary Phone: [PRIMARY CONTACT PHONE 1] Secondary Phone: [PRIMARY CONTACT PHONE 2] Provide a second number where possible.

Secondary Emergency Contact

Full Name: [SECONDARY CONTACT NAME] Relationship to Child: [SECONDARY CONTACT RELATIONSHIP] Primary Phone: [SECONDARY CONTACT PHONE 1] Secondary Phone: [SECONDARY CONTACT PHONE 2] To be contacted only if the primary contact cannot be reached.

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Section 5: Medical Information

This information is collected solely to ensure the safety and wellbeing of your child during the trip. It will be shared only with staff directly responsible for your child on the day and held securely. Please complete all fields; write “None” where a field does not apply.

Child’s Family Doctor / GP Name: [DOCTOR NAME] (Recommended) In case medical history is needed in an emergency.

GP Practice / Clinic Phone: [DOCTOR PHONE]

Health / Insurance Card Number: [HEALTH CARD OR INSURANCE NUMBER] (Recommended) May help accelerate treatment in some countries.

5a. Medical Conditions

Does the child have any diagnosed medical conditions, chronic illnesses, or ongoing health needs (e.g. asthma, diabetes, epilepsy, heart condition)?

☐ No ☐ Yes — If yes, please describe:

[MEDICAL CONDITIONS DETAIL] State the condition, any triggers, and what action staff should take.

5b. Allergies

Does the child have any allergies (food, medication, environmental, insect stings, etc.)?

☐ No ☐ Yes — If yes, please complete the table:

Allergen	Type (Food / Medication / Environmental / Other)	Severity (Mild / Moderate / Severe / Anaphylactic)	Action Required
[ALLERGEN 1]	[TYPE]	[SEVERITY]	[ACTION]
[ALLERGEN 2]	[TYPE]	[SEVERITY]	[ACTION]

For anaphylactic reactions: confirm below whether an auto-injector (e.g. EpiPen) will be carried.

Auto-injector prescribed? ☐ No ☐ Yes — Carried by: ☐ Child ☐ Staff member

5c. Medications

Does the child need to take any medication during the trip?

☐ No ☐ Yes — If yes, please complete the table:

Medication Name	Dose	Time(s) to be Given	Storage Requirements	Prescription / OTC
[MEDICATION 1 NAME]	[DOSE]	[TIMING]	[STORAGE]	[RX/OTC]
[MEDICATION 2 NAME]	[DOSE]	[TIMING]	[STORAGE]	[RX/OTC]

I authorise staff to administer the medication(s) listed above: ☐ Yes ☐ No

If yes, please ensure medication is provided in its original labelled container with written administration instructions attached.

5d. Dietary Requirements

Does the child have any dietary requirements beyond those related to allergies listed above (e.g. vegetarian, halal, kosher, lactose-free)?

☐ No ☐ Yes — If yes, please describe: [DIETARY REQUIREMENTS]

5e. Mobility and Accessibility Needs

Does the child have any mobility, sensory, or accessibility needs that staff should be aware of for transport or at the venue?

☐ No ☐ Yes — If yes, please describe: [ACCESSIBILITY NEEDS]

5f. Behavioural / SEND / IEP Notes

Is the child the subject of any Individual Education Plan, support plan, or documented behavioural / SEND needs that staff should be aware of?

☐ No ☐ Yes — If yes, please describe or attach relevant information: [SEND OR BEHAVIOURAL NOTES]

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Section 6: Activity-Specific Authorisations

6a. Swimming / Water Activities

Does this trip involve swimming or any water-based activity?

☐ Not applicable

If applicable:

I authorise my child to participate in swimming / water activities: ☐ Yes ☐ No

Child’s swimming ability: ☐ Non-swimmer ☐ Weak / beginner ☐ Competent swimmer This information is used to assign appropriate supervision.

6b. Photography and Video

During the trip, photographs or short video clips may be taken by authorised staff.

(i) Internal use — for [ORGANISATION NAME] records, internal newsletters, noticeboards, or displays: I consent to my child being photographed / filmed for internal use: ☐ Yes ☐ No

(ii) Public or external use — for publication on the organisation’s website, social media channels, or external communications: I consent to my child being photographed / filmed for public / external use: ☐ Yes ☐ No

You may consent to internal use while declining public use. Both consents can be withdrawn in writing at any time.

Social media notice: Families are kindly asked not to post photographs that clearly identify other children on public social media channels without the consent of those children’s parents.

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Section 7: Child Collection Arrangements

The child will return to [RETURN LOCATION] at approximately [RETURN TIME].

Who will collect the child at the end of the trip?

☐ Child will travel home independently (secondary students only, where school policy permits) ☐ Child will be collected by:

Authorised Person 1 — Full Name: [AUTHORISED COLLECTOR 1 NAME] Relationship: [AUTHORISED COLLECTOR 1 RELATIONSHIP] Phone: [AUTHORISED COLLECTOR 1 PHONE]

Authorised Person 2 — Full Name: [AUTHORISED COLLECTOR 2 NAME] (optional) Relationship: [AUTHORISED COLLECTOR 2 RELATIONSHIP] Phone: [AUTHORISED COLLECTOR 2 PHONE]

If an adult who is not listed here attempts to collect the child, staff are instructed to contact the primary emergency contact before releasing the child.

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Section 8: Emergency Medical Treatment Authorisation

In the event that my child requires urgent medical attention during the trip, and staff are unable to reach either emergency contact in time, I authorise staff to seek emergency medical treatment on my child’s behalf — including calling emergency services, accompanying my child to a medical facility, and consenting to necessary first aid or stabilising treatment pending my arrival.

This authorisation allows staff to act in your child’s best interests while every reasonable effort is made to contact you. It is not a full medical power of attorney and does not override your parental rights.

☐ I grant this emergency medical treatment authorisation

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Section 9: Parental / Guardian Consent Declaration

By signing below, I confirm that:

1. I have read and understood the trip details, planned activities, and known risks described in Section 2.
2. I have provided accurate and complete medical and emergency contact information in Sections 4 and 5.
3. I give consent for [CHILD FULL NAME] to participate in [TRIP NAME] on [TRIP DATE(S)].
4. I understand that I may withdraw this consent in writing to [CONTACT EMAIL] at any time before the departure date, subject to the refund policy stated in Section 2.
5. I understand that [ORGANISATION NAME] may need to take photographs of the child or access medical information as described in this form.

Parent / Guardian Full Name: [PARENT GUARDIAN FULL NAME] As it appears on official documents.

Relationship to Child: [PARENT GUARDIAN RELATIONSHIP] E.g. “Mother,” “Father,” “Legal Guardian,” “Foster Carer.”

Signature: ___________________________________

A handwritten signature is preferred. If this form is submitted electronically, a typed name may be accepted in accordance with [ORGANISATION NAME]‘s electronic consent policy — please confirm with the organisation if you are unsure.

Date Signed: [SIGNATURE DATE]

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Section 10: Student Assent (Recommended for pupils aged approximately 11 and above)

This section is based on best-practice principles recognising that older children should, where appropriate, have a voice in decisions that affect them. It does not replace parental consent. Adapt the age threshold to your local policy, governing body guidance, or the individual child’s assessed maturity — some SEND/IEP frameworks set different thresholds.

I, [CHILD FULL NAME], understand that I will be attending [TRIP NAME] on [TRIP DATE(S)]. I understand the activities planned and the rules I am expected to follow. I agree to take part and to follow the safety instructions given by staff.

Student Signature: ___________________________________ Date: [STUDENT ASSENT DATE]

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Section 11: Data Protection / Privacy Notice

Who holds this data: [ORGANISATION NAME], [ORGANISATION ADDRESS].

Purpose: The personal data on this form is collected solely to organise and manage your child’s safe participation in [TRIP NAME].

Data shared with: Supervising staff named in Section 2, emergency services if required, and the venue or transport provider where necessary for operational purposes.

Retention: This form will be retained for [RETENTION PERIOD, E.G. “12 months after the date of the trip”] and then securely destroyed, unless a safeguarding or insurance matter requires longer retention.

Your rights: You have the right to access, correct, or request deletion of your personal data. Contact [CONTACT EMAIL] to exercise these rights.

This organisation processes personal data in accordance with applicable data protection law and its own privacy policy, available at [PRIVACY POLICY URL OR “on request”].

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Section 12: For Organisation Use Only

Form received by (staff name): [RECEIVED BY NAME]

Date received: [DATE RECEIVED]

Payment confirmed: ☐ Yes ☐ No ☐ N/A — Amount received: [PAYMENT AMOUNT]

Medical information noted and passed to lead supervisor: ☐ Yes ☐ N/A

Medication received from parent: ☐ Yes ☐ No ☐ N/A — Quantity / description: [MEDICATION RECEIVED DESCRIPTION]

Medication returned to parent after trip: ☐ Yes ☐ No ☐ N/A — Returned by: [MEDICATION RETURNED BY] on [MEDICATION RETURN DATE]

Notes: [ADMIN NOTES]

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Version: 1.0 | Template issued by [ORGANISATION NAME] | Review date: [TEMPLATE REVIEW DATE]

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How to Use This Template

• Customise before distribution. Replace every [BRACKETED PLACEHOLDER] in Section 1 and Section 2 with your organisation’s actual details before sending the form to families. Never send a form with unfilled organisation or trip fields — parents cannot give informed consent without this information.

• Complete Section 2 fully, especially the risks field. Leaving the “Known and Foreseeable Risks” field blank or vague undermines informed consent and your duty of care. Be specific about the activities and environment (road travel, water proximity, outdoor terrain, contact sport, etc.).

• Distribute with enough time for families to read, ask questions, and return the form. A minimum of two weeks before departure is strongly recommended. Late returns or incomplete forms should be followed up promptly — do not permit a child to travel without a signed, complete form.

• Check every returned form for completeness. Before the trip, confirm that Sections 4, 5, 8, and 9 are fully completed. Incomplete medical or emergency contact sections should be returned to the parent for completion. Transfer any medical flags (allergies, medications, conditions) to your staff briefing sheet.

• Retain the originals securely. Store completed forms in a locked file, accessible only to the trip coordinator and lead supervisor. Bring copies of each child’s medical and emergency contact sections on the day. Destroy forms after your stated retention period.

• This template is a general guide, not legal advice. Requirements, terminology, and best practices vary between countries, sectors, and regulatory bodies. Have your template reviewed by your organisation’s safeguarding lead, legal adviser, or relevant governing body before first use, and revisit it whenever your activities or policies change significantly.