Parent Consent Form Template

<form action="https://splitforms.com/api/submit" method="POST">
  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
  <input type="hidden" name="subject" value="Parent consent form">
  <input type="hidden" name="consent_version" value="2027-01">
  <input type="hidden" name="form_loaded_at" id="form_loaded_at">

  <section>
    <h2>About this activity</h2>
    <!-- Replace with your details. Have your organization (or a lawyer) review the wording. -->
    <p>[Activity name, where it happens, dates and times, how children travel,
      who supervises, any cost, and what parents are agreeing to.]</p>
  </section>

  <fieldset>
    <legend>Child</legend>
    <label>Child's full name <input type="text" name="child_name" required></label>
    <label>Class, group or team <input type="text" name="child_group"></label>
  </fieldset>

  <fieldset>
    <legend>Activity</legend>
    <label>Activity or trip <input type="text" name="activity" required></label>
    <label>Date (or first day) <input type="date" name="activity_date" required></label>
    <label>Last day, if more than one day <input type="date" name="activity_end_date"></label>
  </fieldset>

  <fieldset>
    <legend>Parent or guardian</legend>
    <label>Full name <input type="text" name="guardian_name" autocomplete="name" required></label>
    <label>Relationship to child
      <select name="relationship" required>
        <option value="">Choose one</option>
        <option>Parent</option>
        <option>Legal guardian</option>
      </select>
    </label>
    <label>Email <input type="email" name="email" autocomplete="email" required></label>
    <label>Phone during the activity <input type="tel" name="guardian_phone" autocomplete="tel" required></label>
  </fieldset>

  <fieldset>
    <legend>Emergency contact (if we cannot reach you)</legend>
    <label>Name <input type="text" name="emergency_name" required></label>
    <label>Phone <input type="tel" name="emergency_phone" required></label>
  </fieldset>

  <fieldset>
    <legend>Pickup</legend>
    <label>Who will pick your child up? <input type="text" name="pickup_person" required></label>
    <label>Their phone <input type="tel" name="pickup_phone"></label>
  </fieldset>

  <fieldset>
    <legend>Does your child have allergies staff should know about?</legend>
    <label><input type="radio" name="allergies" value="no" required> No</label>
    <label><input type="radio" name="allergies" value="yes"> Yes</label>
    <label>If yes: what, and what staff should do (e.g. carries an auto-injector)
      <textarea name="allergy_note" rows="3"></textarea>
    </label>
  </fieldset>

  <fieldset>
    <legend>Your decision</legend>
    <label><input type="radio" name="consent" value="yes" required> I give permission for my child to take part</label>
    <label><input type="radio" name="consent" value="no"> I do not give permission</label>
  </fieldset>

  <label><input type="checkbox" name="agreed" value="yes" required>
    I am this child's parent or legal guardian, I have read the activity details, and the information above is correct.</label>

  <label>Type your full name
    <input type="text" name="typed_name" required>
  </label>

  <!-- honeypot: leave empty -->
  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">

  <button type="submit">Submit consent form</button>
</form>
<script>
  document.getElementById('form_loaded_at').value = Date.now();
</script>