Consent Form for Minors
This Consent Form parts A and B must be completed by the test taker and the parent /
guardian before the minor can take the test.
A minor cannot complete test day check procedures without a signed copy of this form.
This form must be brought and presented to the administrator on test day.
Parents / Guardians seeking a chaperone opt out under section 2. Provisions below must
submit this form to the Test Centre at least 7 calendar days before test date. (At the
discretion of the test centre, opt-out forms may be accepted within 7 days of test date.)
This form applies to all IELTS Speaking interviews. It also applies to special access
arrangements for Writing, Reading or Listening when a test taker alone with a helper.
A chaperone must be assigned in all cases except when a waiver is granted. See section
2. regarding waivers.
Read sections 1. – 3. Complete parts A and B and submit the form to your Test Centre
at least 7 days before the test date.
1. The test centre will provide a chaperone as required. Apart from the examiner or
special access facilitator, only the chaperone will be allowed in the speaking room
with the minor.
2. A parent/legal guardian who does not want the test taker to be accompanied by a
chaperone on test day, can request a waiver if…
• the test taker is at least 15 years of age on the test date.
• the parent/guardian contacts the test centre in writing at least 7 calendar days
before test date with A and B of this consent form completed.
3. Test Centre duty of care regarding the minor ends when the minor is returned to a
responsible legal guardian after the test, or, in case a responsible legal guardian is
absent, returned to the publicly accessible areas of the test location.
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and Cambridge English, part of Cambridge University
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A – For completion by Parent/Legal Guardian
I have read, understood, and accept the conditions on this form.
[Print in CAPITALS]
Full name (Parent or Legal Guardian)
SAMIR IBRAHIM AHMED
Signature (Parent/ Legal Guardian) Signed:
Date: 8/6/2024
Tick one box only.
I consent for the test centre to arrange a chaperone for the test taker named in
part B.
The test taker meets the conditions in section 2. and I do not wish the test centre
to arrange a chaperone for the test taker named in part B.
Mobile number
01007479333
B - For completion by the IELTS test taker
[Print in CAPITALS]
Full name (Test Taker)
NOURHAN SAMIR IBRAHIM
Signature (Test Taker) Signed:
Date: 8/6/2024
Age on test day
____
17 years and _____
10 months
IELTS is jointly owned by the British Council, IDP: IELTS Australia,
and Cambridge English, part of Cambridge University
Press & Assessment
IELTS.org
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