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1. Parent/Guardian Information: Full legal name, address, and contact details of the parent(s) or legal guardian(s) giving consent
2. Child Information: Full legal name, date of birth, and any relevant identification information of the child
3. Authority Statement: Clear statement establishing the parent's/guardian's legal authority to give consent
4. Purpose of Consent: Specific description of the activity, treatment, or purpose for which consent is being given
5. Scope of Permission: Clear delineation of what is being authorized, including any specific limitations or conditions
6. Duration: Time period for which the consent is valid, including start and end dates if applicable
7. Emergency Contact Information: Alternative contact details in case parents/guardians cannot be reached
8. Signature Block: Space for date, signature(s) of parent(s)/guardian(s), and any required witness signatures
1. Medical Information: Include when consent involves medical treatment or activities where medical information might be relevant
2. Travel Details: Include when consent involves travel or transportation arrangements
3. Photography/Media Release: Include when activities might involve taking photos or videos of the child
4. Third Party Authorization: Include when other adults need authorization to make decisions in parents' absence
5. Special Needs/Requirements: Include when the child has specific needs that caregivers should be aware of
6. Revocation Clause: Include when consent needs to be revocable, specifying how and when consent can be withdrawn
1. Schedule A - Activity Details: Detailed description of activities, events, or treatments being authorized
2. Schedule B - Medical History Form: Optional detailed medical information form when relevant to the consent being given
3. Schedule C - Emergency Protocols: Specific instructions for emergency situations, if applicable
4. Appendix 1 - Copy of Parent/Guardian ID: Copy of official identification document of parent/guardian giving consent
5. Appendix 2 - Supporting Documentation: Any additional documentation required to support the consent (e.g., court orders for sole custody)
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