APARTMENT HOTEL MIMARU_Parental Consent Form

Parental Consent Form

Submission of a parental consent form is required for a stay of a minor (when more than one guest is staying, a consent form from one parent (guardian)). Personal information provided here will not be provided or disclosed to any third party without prior consent of the guest.
As a parent (guardian) of the minor named below, I consent to him/her staying at *
and understand the hotel may contact me in the event such is deemed necessary. *

月日年
Date of signature.

▶For the guest
Name *
Period of stay：From *

月日年
Period of stay：To *

月日年
No. of guests *
Date of birth *

月日年
Age *
Address *

Street Address

Country

Postal code
Telephone number *
▶For the parent (guardian)
Signature of parent (guardian) : *

Clear
Relationship *
Address *

Street Address

Country

Postal code
Telephone number *
Please check that the information you have entered is correct and click "Submit".Please wait for a while until the "Thank you!" screen appears.
Should be Empty: