Draft for attorney review. This is the record captured at signup (in person, on a tablet, or via the member registration form) before a minor's Member record is created. Each field below maps to a property on MemberConsent so the record captured matches what's stored: GuardianName, GuardianContactValue, PolicyVersion (the version of the Guardian Privacy Notice being agreed to), ConsentedAtUtc, ConsentedByUserId (the staff member who captured it, if not self-service), and ConsentText (a snapshot of the exact wording agreed to — store the text below, not just a boolean, so you can prove what was agreed even after the notice is later updated).

Parental / Guardian Consent Form

[Organization Name]

Child's / Member's name: ___________________________ Date of birth: ___________________________

Parent/Legal guardian name: ___________________________ Relationship to child: ___________________________ Contact number or email: ___________________________

What you are agreeing to

By signing below, I confirm that I am the parent or legal guardian of the child named above, and I consent to [Organization Name] collecting and using the following information about my child, as described in the Privacy Notice for Parents & Guardians (version [X], dated [DATE]), which I have read and had the opportunity to ask questions about:

• Their first and last name, and date of birth (used only to place them in the correct age group for sessions; date of birth is visible only to organization administrators and is never shared publicly or printed).
• Group tags used solely to organize them into the correct sessions/classes.
• Attendance records for the sessions they participate in.
• An emergency contact I provide, to be used only if a responsible adult needs to be reached during a session. I understand no contact details belonging to my child are collected or used for any purpose.
• Where I am the paying account holder: my own billing name and postal address, used only for invoicing.

Important — health and medical information

I understand that [Organization Name]'s systems do not have a dedicated field for health, medical, allergy, or dietary information, and I have been asked not to enter any such information into any name, note, or tag field in this system. If my child has a medical condition, allergy, or other health need that staff should be aware of, I will communicate this separately and directly to staff (not through this registration system).

Consent is specific and can be withdrawn

I understand that:

• This consent covers only the uses listed above; any new use of my child's information will require my separate consent.
• I can withdraw this consent at any time by contacting [Organization Name] at [contact email/phone], which will result in my child's record being removed from active use, subject to any information the Organization is legally required to retain (for example, financial records relating to fees already paid).
• I can request a copy of, correction to, or deletion of my child's information at any time using the same contact details.
• Personal information about my child is retained for 24 months after their last recorded activity, after which it is anonymized or deleted as described in the Privacy Notice.

Parent/Guardian signature: ___________________________ Date: ___________________________

Captured by (staff member, if applicable): ___________________________

Internal use — do not print for the parent's copy: record this consent in the system against the Member as a MemberConsent entry, storing this exact wording (with the version/date filled in) in ConsentText, and set PolicyVersion to the Guardian Privacy Notice version referenced above. Do not allow the Member record to be created or activated until this is on file.