Parent or guardian consent form

Complete our 2 minute consent form prior to attending any LearnSmart Academy course for the first time!

Please note, all details entered below will only be used in the case of emergency, not for any marketing activities. All information will be kept confidential and will not be shared with any third parties.

Name

First Name

Last Name

Relationship to child

Email Address

Emergency contact number

Additional emergency contact number (optional)

Address

In case of emergency

Child's name

Child's date of birth

YYYY

Does your child suffer any medical condition or allergy you think the course leader should know about (including any current medication)?

Does your child have any dietary requirements we should be aware of?

CONSENT (please read carefully)

- I agree to my son/daughter taking part in the academic activities in the course - I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition, allergy or dietary requirements other than those listed above - I consent to my son/daughter travelling by motor vehicle driven by an academy tutor if train station drop-offs are required - I consent to my contact details being held for the case of an emergency and for communicating important course confirmations and reminders. - I understand that the academy accepts no responsibility for any loss, damage or injury caused by or during any courses attended unless where such loss, damage or injury can be shown to result directly from the negligence of the academy or the organisers

Today's date

YYYY

Thank you for your time and we look forward to seeing you soon!

01483 236434 | 07887 530066

kathryn@learnsmart.academy

2 Old School House, Guildford, GU3 3QZ