PARENT/GUARDIAN CONSENT FORM FOR GROUP CAREER EXPLORATION
A signed parent/guardian consent form is required of all students under the age of 18 years who wish to participate in
any of the group career exploration sessions at any of the healthcare facilities in northeast Wisconsin. We need your
commitment to stand behind your child’s decision to participate in this experience.
Group career exploration allows the opportunity to observe healthcare professionals working in a particular
occupation(s). This valuable experience will assist your son/daughter in making realistically informed choices about
their future career.
Site of the Group Career Exploration Session: Click here to enter text.
Date of the Group Career Exploration Session: Click here to enter a date.
Start Time: Click here to enter text.
End Time: Click here to enter text.
Site Coordinator’s Name & Contact Information: Click here to enter text.
School Coordinator’s Name & Contact Information: Click here to enter text.
STUDENT INFORMATION
Student’s First Name: Click here to enter text.
Student’s Last Name: Click here to enter text.
Date of Birth: Click here to enter text.
Grade: Click here to enter text.
School Currently Attending: Click here to enter text.
Home Phone w’ Area Code: Click here to enter text.
Cell Phone w’ Area Code: Click here to enter text.
Email Address: Click here to enter text.
PARENT/GUARDIAN CONSENT INFORMATION
Medical Authorization – Should it be necessary for my child to receive medical treatment while participating in this
group career exploration session, I hereby give workplace and/or school district personnel permission to use their best
judgment in obtaining medical treatment for my child. Permission is also granted to the school system to release
necessary emergency contact/medical history to the attending physician, if needed.
☐
I GIVE PERMISSION for my student to participate in the group career exploration session at the site and on the
dates listed above.
☐
I DO NOT give permission for my student to participate in the group career exploration session at the site and on
the dates listed above.
Parent/Guardian Name(s): Click here to enter text.
Cell Phone w’ Area Code: Click here to enter text.
Home Phone w’ Area Code: Click here to enter text.
Work Phone w’ Area Code: Click here to enter text.
Email Address: Click here to enter text.
Parent/Guardian Signature: __________________________________________________________________________
Today’s Date: _____________________________________
Parent/Guardian: Please make a copy of this completed form for your records.
Parent/Guardian Consent Form
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Updated 5/7/2013