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Registration and General Consent Form (Under 18)

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Registration & General Consent Form (Under 18)

Appendix 6.0

Mae Murray Foundation
Creating Change Together

Name of young person

Likes to be called

Date of birth Age

Address

Postcode

Mobile telephone number (if they have one)

With whom does the child/young person live?

Relationship to the child/young person

Who has parental responsibility for the child/young person?

Name

Address (if different to above)

Postcode

Contact number(s)

E-mail address

Emergency contact details

(this should be the person who would be able to respond in the case of an emergency).

1st Contact

Name

Contact number(s)

Address

Postcode

Relationship to child

2nd Contact

Name

Contact number(s)

Address

Postcode

Relationship to child

Medical details

Is tetanus injection up to date? Yes No

Any known medical conditions or disability? Please give full details

Describe your mobility and list any mobility equipment used and frequency

e.g. wheelchair user just for long distances, powered wheelchair used all the time, walk unaided etc

Food allergies or special requirements

Details of any medication currently being taken

Can the young person self-administer medication? Yes No

Will any medication be needed whilst at event? Yes No

If assistance is needed with medication please contact us on 07900 278780.

Doctor information

Name of family doctor

Telephone number

Address

Postcode

More detail

Feeling Included - specific likes and dislikes, having a particular person identified to provide support, the session not being too noisy, participation in groups. Food I like. Food I don’t like. Activities I like / don’t like. My interests and dislikes

Choices/Decisions – Is support required to help with choices and decision making?

e.g. choosing own food or drinks, staying safe generally

Communication - this may include: sign interpretation, makaton, communication boards, assistive technologies, symbols, induction loops, braille, simple language etc. Preferred communication method, other methods, Communication equipment required, any other considerations

Personal care requirements - these may include support with going to the toilet, dressing, eating, drinking, means of transferring, support handling money and any other specific directions you wish to give:

Parent/guardian Authorisation

I give permission for to take part in the normal activities of this group. I understand that separate permission will be sought for certain activities, including outings lasting longer than the normal meetings times of the group.

In an emergency and/or I cannot be contacted, I am willing for my child to receive necessary hospital or dental treatment including anaesthetic as deemed necessary by medical professionals.

Signature of parent/guardian (or adult with parental responsibility):

Print name:

Date:

Data protection

The Mae Murray Foundation values personal privacy and all information collected will be stored in line with our Data Protection Policy and Procedures. A copy is available upon request. This information will always be kept safe and secure. We will not share your information with any third party. You can view our full Privacy Policy by visiting our website: www.maemurrayfoundation.org.

We would like to correspond with you about membership benefits, events, projects design, and how we can improve the service we provide to you and/or your family. We may also send information from other organisations that may be of benefit to you and your family. We will correspond with you in a variety of ways such as: by post, telephone, email and SMS. If you agree to your information, which is essential for safe-guarding to be stored in line with data protection procedures and to being contacted this way, please sign below:

Signature of parent/guardian (or adult with parental responsibility):

Print name:

Date:

Residential Information and Consent

The following must be discussed with and agreed by young person, involving significant others and best interest decision made. Please place an X beside choice.

the event leader to sign, on my behalf, any form of written consent required by hospital authorities should medical treatment be required and any delay in requiring my permission to do so would, in the opinion of the doctor/surgeon, endanger health or safety

Yes No

medication to be administered as per the medical sheet provided and signed by the parent/carer and GP

Yes No

to be included in photographs or films as per separate consent form

Yes No

to wear any soft restraints other than a lap belt eg foot straps etc at times OTHER than in transport. Please list

Yes No

to have bed sides raised (where applicable)

Yes No

to remain in my wheelchair; which has I confirm has been crash tested, during transport in a vehicle

Yes No

to receive night time monitoring through either listening device or regular visual checks (where required)

Yes No

for my money to be kept by others and signed out as required (if required)

Yes No

to take part in activities of my choosing

Yes No

to be hoisted using own sling for transfers, following individual assessment

Yes No

Overnight routines or requirements we need to know about.

Please detail your night time requirements including support required, how you seek support

Please list anything else which will need to be attended to eg charge electric chair etc

Please detail any other equipment required or which you wish to provide along information in respect of showering eg. Shower chair, flip down seat, changing bed etc

Medical/Nursing Assistance or Intervention

If assistance with administration of medication is needed, or if our staff will be required to assist with any specific medical or nursing need - which may require specific training, then please ask your GP to complete the details below and submit it to us as soon as possible. We will need to assess this need to ensure we have staff with appropriate training before confirming participation in a residential. Thank you.

Medication / Dosage / Frequency

Please state any medical/nursing need eg. colostomy etc or any assistance which may need to be given to the below named patient which requires specific medical training; eg epileptic seizures etc

I confirm that the above information hereby given in respect of the below named patient is correct as of (date)

(Name of patient) D.O.B.

GP Signature

I being the legal guardian of the above named person hereby agree to immediately inform the Mae Murray Foundation of any changes to this information.

SIGNED Date

Parent/guardian Residential Break Authorisation

I give permission for to take part in a residential break, including any activities of his/her choice unless I have expressly directed otherwise on the Participant Registration Form.

I also agree to ensure that all any equipment I send will be in good repair. However, in the event of breakdown, I give permission for any temporary intervention which may be deemed necessary to ensure safety.

In an emergency and/or I cannot be contacted, I am willing for my child to receive necessary hospital or dental treatment including anaesthetic as deemed necessary by medical professionals.

Signature of parent/guardian (or adult with parental responsibility):

Print name:

Date:

Data protection

The Mae Murray Foundation values personal privacy and all information collected will be stored in line with our Data Protection Policy and Procedures. A copy is available upon request. Young people can request to see information we hold about them at any time. This information will always be kept safe and secure.

Please delete as appropriate:

• I give my permission for this information, which is essential for Safe-guarding to be stored in line with Data Protection procedures.

Signature of parent/guardian (or adult with parental responsibility):

Print name:

Date:

For Office Use Only

Date form checked :

Telephone assessment completed : Y / N Date :

Home visit completed : Y / N Date :

Other Notes

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What this Registration and General Consent Form (Under 18) is

The Registration and General Consent Form (Under 18) is a combined enrollment and parental/guardian authorization used to register a minor for programs, activities, medical care, transportation, or events. It documents the child’s identity, emergency contacts, health information, and the parent/guardian’s permission for participation, treatment, photo release, and data sharing. The form creates a clear record of consent and responsibilities, and when properly executed it supports administrative processing, risk management, and compliance with applicable privacy laws such as HIPAA for medical information and ESIGN/UETA for electronic signatures.

Why a clear consent form matters for minors

A concise Registration and General Consent Form (Under 18) reduces administrative friction, clarifies parental permission and medical authority, and creates a reproducible record for regulatory and liability purposes. Properly completed forms support emergency response and help organizations meet privacy and recordkeeping obligations.

Why a clear consent form matters for minors

Who typically completes this form and why it matters

Organizations that register minors rely on this form to document permission, emergency contacts, and any medical or accommodation needs before participation.

  • Schools and districts enrolling students for classes, field trips, or extracurricular programs; used for attendance, health, and transport authorization.
  • Healthcare clinics and sports programs collecting treatment consent, immunization status, and HIPAA-compliant authorization for sharing medical information when required.
  • Camps, youth sports, and community organizations documenting parental consent, photo release, emergency plans, and liability acknowledgments for minors.

Use consistent templates and signature methods to reduce errors and ensure the form is enforceable and retrievable when needed.

Core components every professional consent form should include

A properly designed Registration and General Consent Form (Under 18) balances clarity with completeness: identify the minor and guardian, describe the scope of consent, capture medical details, and provide clear signature and retention provisions.

Child and Guardian Identity

Full legal name, date of birth, relationship to guardian, and government ID when applicable; needed for verification and emergency response.

Contact and Emergency Details

Primary phone, alternate contacts, primary care physician, and emergency procedures so staff can act quickly in medical or safety events.

Scope of Consent

Specific permissions (participation, transport, field trips, medical treatment, medication administration, and off-site activities) with clear start and end dates.

Medical and Allergy Information

Current medications, allergies, chronic conditions, and special instructions so authorized personnel can provide appropriate care or accommodations.

Photo/Media and Data Release

Separate checkbox for photography/video and data sharing permissions, including any limits on publication or third-party disclosure.

Signature and Acknowledgment

Parent/guardian signature, printed name, relationship, and date; fields for witness or notarization if the organization or state requires additional authentication.

Step-by-step: completing the form

Follow these ordered steps to collect valid consent and minimize follow-up.

  • 01
    Gather documents: Collect child ID and guardian ID for verification.
  • 02
    Complete fields: Enter name, DOB, contacts, and medical details accurately.
  • 03
    Select consents: Check only the permissions you intend to grant.
  • 04
    Sign and record: Guardian signs, date added, and form stored in records.

Practical tips to ensure forms are complete and usable

Adopt these best practices to reduce ambiguity, satisfy legal requirements, and speed administrative processing.

Confirm full legal names and dates match official records
Cross-check the minor's name and date of birth against school or medical records before finalizing. Consistency prevents identity confusion during emergencies and supports accurate billing or reporting.
Use separate, explicit checkboxes for each consent type
Avoid combined or vague consent language. Provide individual boxes for medical treatment, medication administration, transport, and photography so permissions are clear and auditable.
Keep medical detail fields current and precise
Ask guardians to update medications and allergies annually or whenever treatment changes. Up-to-date records reduce treatment errors and support compliance with medical privacy laws.
Document the method of signature and authentication used
Record whether signature was wet, e-signed, or notarized and note any multi-factor authentication. This supports legal validity under ESIGN and state UETA frameworks.

How to configure an online completion workflow

Configure these settings when building an electronic workflow to collect and store consents securely.

Field Configuration
Consent Scope Use separate checkboxes and required validation.
Notifications Email confirmations to guardian and administrator.
Authentication Email link or SMS code; stronger auth for medical forms.
Retention Set automatic archival and access controls per policy.

Digital signing and platform considerations

Choose a platform that supports secure e-signatures, audit trails, and the authentication level appropriate for medical or parental consent forms.

  • Authentication Options: Email, SMS code, KBA as needed.
  • Audit Trail: Timestamps, IP, and signer attribution.
  • Integrations: Connect to SIS, EMR, or cloud drives.

Typical routing after a form is signed

A standard electronic workflow routes the completed form to administrators, stores the signed copy, and notifies parents and relevant staff for action.

  • Send to Administrator: Signed copy delivered to program admin inbox.
  • Record in Files: Store in student/participant record with metadata.
  • Share with Providers: Share medical details only with authorized clinicians.
  • Provide Copy: Guardian receives the completed form copy automatically.

Timing and deadlines you should track

Set clear deadlines to ensure consent is valid and current for the scheduled activity.

Registration window:

Open and close dates for sign-up and payment.

Consent due before participation:

Consent must be received prior to event start.

Annual medical updates:

Update health data at least once per year.

Notarization window if required:

Schedule notarization before document-dependent deadlines.

Retention notice:

Inform guardians how long records are kept.

Key milestones from issuance to record retention

Track milestone stages so each form moves through verification, acceptance, and storage with clear responsibility.

01

Form Issued

Organization publishes form and distribution link for guardians.

02

Consent Received

Guardian completes and signs the form electronically or on paper.

03

Verification Completed

Administrator verifies identity and required fields are present.

04

Records Filed

Signed document archived in the official participant record.

Typical vendor pricing and compliance features for e-signature solutions

Compare starting prices and core compliance features when selecting an e-signature provider; signNow is listed first per table requirements.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes (Business Premium) Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes (BAA) Yes Yes No No

Required information typically collected on the form

Child Name: Full legal name
Date of Birth: MM/DD/YYYY
Guardian Name: Full name & relationship
Contact Phones: Primary and alternate
Emergency Contacts: Name and phone
Medical Details: Allergies, meds, conditions

Common risks and consequences of incorrect or incomplete forms

Invalid Consent: Activity may be legally unauthorized
HIPAA Breach: Potential fines and remediation
Missing Contact: Delay in emergency response
Incorrect Guardian: Legal challenges to authority
Forged Signature: Potential criminal exposure
Late Submission: Denied participation or liability exposure

Common mistakes to avoid when preparing the form

  • Leaving signature date blank, which can render the consent unenforceable for a scheduled activity.
  • Combining multiple permissions into one checkbox, creating ambiguity about what guardians actually authorized.
  • Failing to capture current medical details or emergency contacts, increasing response time in critical situations.
  • Using vague language for data sharing or photo release without specifying purpose, duration, and recipients.

Real-world examples of how organizations use this form

These brief examples show practical outcomes when forms are structured for clarity and secure signing.

Optica Ventures (COO)

Optica simplified customer onboarding with a single online form

  • Ease of use reduced follow-up questions
  • The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers, improving completion and turnaround.

Fertility Centers of Illinois (Founder)

A clinical practice standardized consent and recordkeeping across locations

  • Consistent signatures and audit trails supported compliance
  • The team praised responsive support and the API, enabling secure, compliant collection of patient and guardian authorizations across formats.

Frequently asked questions about Registration and General Consent (Under 18)

Answers to common questions about validity, updating, and electronic signature considerations for minor consent forms.


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