Emergency Release Form

An emergency release form is a formally drafted document which is filled and submitted by those individuals who wish to register the fact that in case of an emergency, their children, friends or loved ones are to be taken care of by the desired people or person. These forms act as proof in the case of an emergency where medical authorities need to sign approval documents in the names of the temporary guardians of children. Any emergency release form consists of many fields which are related to the basic information of the child and the medical condition details as well.

Sample Emergency Release Form:

Emergency Release for Treatment

This form must be completed by parents of the child and should be given to the guardian for use in case emergency attention is required

We, _______________________________________ and ______________________________________________,

(father) and (mother)

the parents of _______________________________________

________________________________________________

(name/names of the child/children in reference to whom this form is being submitted or filled)

give the temporary guardianship of the above said children to: ______________________________________________________

while we are away from _____________________________ (name of current city) to _____________________________________(destination)

The named guardians have full authority to sign and approve any emergency medical care or form of approval that the above mentioned child/children may require.

The children’s primary care physician is:______________________________

(name and telephone number)

The Known(or prevailing) allergies include:

Present medications of the child/children include:

Should notification be necessary, our address is:

__________________________________________________________________

__________________________________________________________________

Should notification be necessary ,our Telephone is :_________________________________________________________

__________________________________________________________________

(signature of father)

__________________________________________________________________

(signature of mother)

__________________________________________________________________

(home address)

Date:______________________________________________________________

Category: Release Forms