"*" indicates required fields InstagramThis field is for validation purposes and should be left unchanged.Name of Child/Individual*Age of Child/Individual at time of consent:*Name of Parent/Guardian (Or individual if over 18 years old)*Legal Responsibility Confirmation*As the above named parent/guardian I can confirm that I have the legal responsibility for this child and legal authorisation to give consent for the child named above to be transported by Family Support Wales staff in their own vehicles or vehicles supplied by Family Support Wales. I give permission for Family Support Wales to transport the above named child as and when needed during the duration of the service. I confirm Travel Risk Assessment*Do you have a travel risk assessment completed by an agency such as social service or facing the challenge? I consent to FSW accessing this assessment I DO NOT consent to FSW accessing this assessment Additional RequirementsPlease give details of any additional restraints/car seat requirements and how to installAdditional InformationPlease give details of any additional information relevant to transporting your childSupervisor/Senior Name:*Supervisor/Senior Signature*Parent/Guardian Name:* First Last Parent/Guardian Signature*Date of consent* MM slash DD slash YYYY If you require more information or clarification on any of the details regarding this consent form on our aim to offer a more visual method to feedback what we do in the community please email info@familysupportwales.co.uk or call 01792 736007
