Display Form | London Zoo

I do hereby affirm that I am the parent/legal guardian.
of the child named

Child Full Name (required)

Child Age (required)

As parent/legal guardian of the child, I hereby grant permission for the child to receive treatment for arachnophobia at The Friendly Spider Programme at the Zoological Society of London.

I understand that the child shall receive hypnotherapy as part of this course. I understand that I may discontinue treatment at any time.

I agree that this treatment will be given under my direct supervision or under the supervision of the following named adult carer:

Adult Carer (required)

Email address (required)

Date of submission (required)

I agree to be present with the child throughout the course or for the above-named adult to be present throughout the course.