Minor Travel Medical Consent Form Template for Netherlands

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Key Requirements PROMPT example:

Minor Travel Medical Consent Form

"I need a Minor Travel Medical Consent Form for my 14-year-old daughter who will be traveling to Germany with her school group from March 15-30, 2025; she has a severe peanut allergy and requires an EpiPen."

Document background

The Minor Travel Medical Consent Form is essential documentation required when minors travel without one or both parents/legal guardians in the Netherlands and internationally. This document becomes crucial in medical emergencies where immediate parental consent cannot be obtained. Compliant with Dutch legislation, including the Civil Code and Medical Treatment Contracts Act, this form enables designated adults to make time-sensitive medical decisions. It typically includes comprehensive medical history, insurance details, and emergency contacts, while respecting GDPR privacy requirements. The form is particularly relevant for school trips, sports competitions, holiday travel with relatives, and any situation where parents are not immediately available to provide medical consent.

Suggested Sections

1. Child Information: Complete details of the minor including full legal name, date of birth, passport number, and home address

2. Parent/Legal Guardian Information: Full details of both parents or legal guardians, including contact information and legal status regarding custody

3. Travel Details: Specific information about the travel dates, destinations, accompanying adults, and purpose of travel

4. Medical Authorization: Explicit authorization for medical treatment, including emergency care, routine medical decisions, and liability provisions

5. Emergency Contacts: List of emergency contacts in both home country and destination, including medical professionals and family members

6. Insurance Information: Details of travel and medical insurance policies, including policy numbers and contact information

7. Signatures and Attestation: Formal signature section for parents/guardians, witnesses, and notary public

Optional Sections

1. Specific Medical Conditions: Detailed information about any chronic conditions, allergies, or ongoing treatments (include when child has specific medical needs)

2. Medication Authorization: Specific permissions for carrying and administering prescription medications (include when child requires regular medication)

3. Special Instructions: Any specific care instructions, dietary requirements, or activity restrictions (include when special care is needed)

4. Additional Parent/Guardian: Information for step-parents or additional legal guardians (include in cases of complex family situations)

5. Translation Section: Official translation of the document in the language of destination country (include for international travel)

Suggested Schedules

1. Schedule A - Medical History: Detailed medical history including vaccinations, past surgeries, and relevant family medical history

2. Schedule B - Medication List: Complete list of current medications, dosages, and administration schedules

3. Appendix 1 - Certified Copies: Copies of relevant documents including birth certificate, passport, and insurance cards

4. Appendix 2 - Emergency Contact Card: Wallet-sized card with key emergency contacts and critical medical information

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Travel & Tourism

Education

Insurance

Legal Services

Aviation

Hospitality

Youth Services

Medical Tourism

Emergency Services

Relevant Teams

Legal

Compliance

Risk Management

Travel Operations

Student Services

Emergency Response

Medical Administration

Insurance Operations

Youth Programs

International Relations

Document Processing

Relevant Roles

Legal Counsel

Travel Coordinator

School Administrator

Risk Manager

Compliance Officer

Medical Administrator

Insurance Agent

Tour Guide

Youth Program Director

Educational Trip Coordinator

Student Exchange Coordinator

Emergency Services Coordinator

Healthcare Administrator

Child Safety Officer

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Let's create your Minor Travel Medical Consent Form

Authors

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