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HYP PARENTAL CONSENT FORM
Data Protection Act. The information being collected on this form will only
be used for the purpose of HYP administration of visits and journeys. The
data will not be disclosed to any external sources other than in an
emergency.
1. Details of visit to:…….........................................................
2. Name of participant:…………………………………………………………………
3. Address ………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
Tel No.…………………………………………………………………………………….
5.

Age ………………. Date of Birth ………………………………………

6. Emergency Address and/or Telephone (if different from above)
………………
.…………………………………………………………………………………………….
7. Personal Information: Please give details requested below or personal
information which might be relevant.
A. Has your child, to your knowledge, been in contact with any infectious
illness in the last three weeks? YES/NO If yes, give details
……………………………….
………………..……………………………………………………………………………
B.