"*" indicates required fields

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.
Travel Risk Assessment*
Do you have a travel risk assessment completed by an agency such as social service or facing the challenge?
Please give details of any additional restraints/car seat requirements and how to install
Please give details of any additional information relevant to transporting your child
Parent/Guardian Name:*
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

This field is for validation purposes and should be left unchanged.