Mission Trip Parent Consent Form

Mission Trip Parent Consent Form

As the parent or legal guardian of a minor requesting to participate in a missions trip, please complete this form to give permission for them to go. This is a requirement for participants who are 18 years old and under.
Name of the Child*

First NameMiddle NameLast Name
Preferred Name/Nickname*
Date of Birth*

MonthDayYear
Date

Travel Details
Name of the Trip Leader*

First NameLast Name
Mission Trip Location and Dates:

Parent/ Guardian's Information
Parent/Guardian's Name*

First NameLast Name
Relationship to child:*

FatherMotherGrandmotherGrandfatherLegal Guardian
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Information about Traveling Child
Is this your child's first time traveling?*
How would you describe your child's spiritual maturity?*
What to you want for your child while on this trip? (for example, what they will learn or expectations)*
What are your expectations for the trip leader for this trip?*

Child's Passport Details
Passport Number
Place of Passport Issuance
Passport Country of Issue
Date of Passport Issuance

MonthDayYear
Date

Child's Health Information
If your child has any physical or mental health conditions or takes any medications please explain:*
Astma, Diabetes, Allergies, Medications
Name of Physician/Pediatrician*

First NameLast Name
Phone Number*
Please enter a valid phone number.

Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Medical Consent
From start of travel to return, I authorize the trip leader to provide for my child the following if necessary:

Routine medical care and treatmentEmergency medical care and treatmentHospitalizationDental care and treatmentOther

Travel Consent
I, {parentguardiansName}, am parent/legal guardian of {nameOf55}, born {dateOf}. I understand that my child will travel to {missionTrip76}. I am giving my permission that my child can travel with {nameOf56} during this trip.
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty: