Medical Release Form Parents

June 30, 2011

A medical release form parents enables a care-giver to seek medical attention for your child in your absence.  There are many non- life threatening ailments which doctors and medical practitioners will not treat without documented parental consent as they risk facing a lawsuit.

Sample Medical Release Form Parents


Child’s name: _________________________ Date of birth: __________________

Name of Pediatrician: ___________________ Tel no: _______________________

Father’s name: _________________________ Tel no: _______________________

Mother’s name: ________________________ Tel no: _______________________

Please fill out the following information concerning your child.

Allergies  recurring illness                Medication             Surgery

_______________ _____________________ _______________ ____________

_______________ _____________________ _______________ ____________

I __________________________ (name of parent (s)) do hereby give my consent to

_______________________ (name of care- giver) to seek medical attention for non- life

threatening ailments for my child ____________________ (name of child) in the event

that I am not present.

Parent’s sig: _____________________ Date: ____________________

Name of notary: __________________________ Sig: ___________

 

Download Medical Release Form Parents in Word Format

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