Parental Consent Form

Student Full Name *

Name as per Passport or official ID

Date of Birth *

Student Phone Number *

Student Email ID *

Student Photograph

Kindly upload latest photograph of the student.

Emergency Contact 1 Name *

Emergency Contact 2 Name *

Emergency Contact 1 Email *

Emergency Contact 2 Email *

Emergency Contact 1 Phone *

Emergency Contact 2 Phone *

Current Ailments/Allergies

Is the Student suffering from any Ailments or allergies? Please provide as much information as possible.

Medicines being administered

Is the Student taking any medicines currently? Please provide details here.

Dietary Requirements

Halal

Gluten-free

Vegetarian

Kosher

I hereby consent to the student named above participating in all aspects of the program.

I hereby consent to the student named above receiving medical treatment, if needed in an urgent situation.

I hereby consent to sharing with other parents the student's photos/videos from the program and activities/excursions.

I hereby consent to use of the student's photos/videos from the program and activities/excursions on CLAN website.

I hereby consent to use of the student's photos/videos from the program and activities/excursions for third party and marketing use. Usage would be in line with CLAN's privacy policy.

Thank You for submitting the Form

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