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Parental Consent Form
Parental consent form
Medical, Publicity, Additional Freedom and Travel
Step 1 of 3
We promise to keep this information secure and will only give it to people who are directly involved in caring for your child on a need to know basis during the time that they are enrolled at the school this may include healthcare and welfare professionals.
Date of Birth
Contact Name for Emergencies
Please make sure he/she can speak English
Contact Phone Number for Emergencies
Relationship to the Student
We will be refering to CC as Country-Cousins. "We" is refering to Country-Cousins as an organization.
I consent to seek Medical Care for my child as necessary when my child is in CC' staff care.
I agree to the organization (CC) staff giving the Student common, non-prescribed medicine, i.e. paracetamol, cough syrup, ibuprophen in case of sickness.
I agree to CC staff giving the Student controlled medicines prescribed by a doctor in the Student's country or in England.
I give permission for CC staff, in an emergency, to follow the advice of attending medical staff and to authorise medical treatment and/or anaesthetic for the welfare of my child.
We take photographs and videos of individuals and groups of students for use in its publicity material and in social media (Facebook and Instagram mainly). Please tick the boxes below if you are willing for the Student to be included in such group photographs/videos.
I consent to photographs being taken of my son/daughter and used in publicity materials, either individually or as part of a group
I consent to videos being taken of my son/daughter and used in publicity materials, either individually or as part of a group
I consent to photos/videos being taken of my son/daughter and used on social media platforms, such as Instagram and Facebook
Students will be met and collected from the airport/train station by trained CC ‘Meet & Greet personnel’ who will be waiting at the Arrivals hall. The student will be accompanied by CC staff to Ilfracombe Devon to begin the course.
I agree for the care arrangements for my child’s travel to, reception and care while in the United Kingdom and confirm that my child has my consent to live and travel independently
CC has curfew times according to the age of students. Students are supervised during the day whilst in lessons and on activities. There are times where the students have additional freedom, for example walking to/from school -home, or meeting up friends on weekends and evenings. For children 11 to 15 years old we will presume they may have additional freedom. Please tick the boxes below accordingly.
I agree with the levels of supervision offered to students at CC and I am aware on additional freedom around town or with staff members at limited times. https://www.country-cousins.com/about-us/policies
The following times indicate when students needs to be back in their accommodation. Up to 10 years old: evening activities only 11 & 12 years old: 9pm 13 & 14 years old: 9.30pm 15 & 16 years old: 10.00pm 17 years old: 10.30pm
I confirm that all the information I have provided is correct to the best of my knowledge.
I confirm that I accept the terms and conditions fo enrolment. (please visit www.country-cousins/terms)
I agree with and Country Cousins Discipline & Exclusion Policy.
https://www.country-cousins.com/about-us/policies I will help Country Cousins to ensure that my son/daughter respects the rules of Country Cousins and homestay.
Post Custom Field
Ilfracombe, North Devon
EX34 8JN, England
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