Overview

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

Letter of consent form

We, MOATAZ SHEHATA MAHMOUD SHEHATA and WALAA ABDELRAHMAN MOHAMED IBRAHIM, declare that we are th
the parents/ of the following child:
ALI MOATAZ SHEHATA MAHMOUD SHEHATA……......, Male/Female, born on
03/02/2010 In HELWAN, passport number A22140924
Our child has consent to travel to UNITED KINGDOM from 06/08/2022 to 13/08/2022
for the purpose of attending multi activity holiday at kingswood inspiring learning camp

Special Medical needs and/or Allergies

My child has the following special medical needs and/or allergies:

- …………N/A…………….
- ………………………………….
- ………………………………….

If there are any questions or concerns regarding this document, we may be contacted at:

Number/Street Address& apartment number: _______________________________________________

City, State/Province, Country: ___________________________________________________________

Telephone and/or Fax Number(s) (work, mobile number & residence) 01003341323 , 01289955559

Signature: __________________________ ______________________ Date: ______05/07/2022____

(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)

Full Name: ___MOATAZ SHEHATA MAHMOUD SHEHATA_______________________________

Signature: __________________________ ______________________ Date: __05/07/2022___

(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)

Full Name: __________WALAA ABDELRAHMAN MOHAMED IBRAHIM___________________________

Signature: __________________________ ______________________ Date: _____05/07/2022_______

(Signature of Custodial Parent, and/or Non-Custodial Parent or Legal Guardian)

You might also like