Collection Consent Form

Child's First Name

Child's Last Name

Name of adult collecting child

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

Name of adult collecting

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

Name of adult collecting

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

Name of adult collecting

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

If there is any person who you sepcifically do not give consent to collect, please speak to Nicola Sexton, KidsStop Manager.

It is the responsibility of the person legally responsible for the child referenced here within this document to ensure that these details are kept up to date and correct. Complete this form again to update us.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

By signing this Collection Consent Form you are confirming that all the information provided is true and accurate at the time of completion.

Collection Consent Form

Child's First Name

Child's Last Name

Name of adult collecting child

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

Name of adult collecting

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

Name of adult collecting

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

Name of adult collecting

Relationship to child

Photo

Upload your file

Choose a file or drag and drop one here.

Consent Type

This person is able to collect my child at any time without prior notification from myself

I will always inform staff on the day of this person is collecting my child

If there is any person who you sepcifically do not give consent to collect, please speak to Nicola Sexton, KidsStop Manager.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

By signing this Collection Consent Form you are confirming that all the information provided is true and accurate at the time of completion.