Kids Medical Release Form
Kids medical release form, as the name suggests, is a document that is used by the healthcare institute/ nursing home/ hospital in order to release the medical details of a child. These types of forms can be used by the parents of the child for admission in school and for other purposes.
Sample Kids Medical Release Form
Details of the kid:
First name: __________ middle name: __________ last name: ___________
Date of birth: ___/ ___/ ____ Age: _________ sex: ___________
Blood group: _______________
Name of the father/ mother/ guardian: _____________
Address:
Street no: _________ city: _________ state: _________ country: _________
Contact number: __________________
Details of the medicinal release form:
Current status of kid’s health: _________ sick/ recovering/ very good
Is there any illness diagnosed during the check up: ________ yes/ no
If the child is suffering from any disease or undergoing any treatment then please provide the details:
________________________________________________________
Details of the hospital:
Name of the hospital: ___________-
Registered Address of the hospital: _______________
Phone number: ______________________________
E-mail id: __________________________________
Website: __________________________________
Name of the concerned doctor: ___________________
Date of release: ____/ ___/ ___
Signed by the hospital authority: ______________
Signed by the parents/ guardian: ______________
Date: ____/ ____/ ____
Seal: ____________________________________
Category: Release Forms
