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Information message
Required for all participants under 16 years of age
Date of programme
I do hereby affirm that I am the parent/legal guardian.
of the child named
Child Full Name
(required)
Child Age
(required)
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:
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.
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.