A medical release form is an important document which all parents should have in order for their children to receive medical care in cases of an emergency when the parent is not present. There are many situations where a parent cannot be with the child such as in school, clubs.
Sample Medical Release Form
Parents’ details:
Father’s name: ___________________________________________________________
Work phone: _____________________________________________________________
Home phone: ____________________________________________________________
Mobile number: __________________________________________________________
Address: ________________________________________________________________
Email: __________________________________________________________________
Mother’s name: __________________________________________________________
Work phone: _____________________________________________________________
Home phone: ____________________________________________________________
Mobile number: __________________________________________________________
Address: ________________________________________________________________
Email: __________________________________________________________________
Children’s details:
First name: ______________________________________________________________
Middle name: ____________________________________________________________
Last name: ______________________________________________________________
Any known allergies: ______________________________________________________
Current medical condition: _________________________________________________
First name: ______________________________________________________________
Middle name: ____________________________________________________________
Last name: ______________________________________________________________
Any known allergies: ______________________________________________________
Current medical condition: _________________________________________________
Current Pediatrician:
Name: __________________________________________________________________
Tel number: _____________________________________________________________
Mob number: ____________________________________________________________
Current GP:
Name: __________________________________________________________________
Tel number: _____________________________________________________________
Mob number: ____________________________________________________________
Current Dentist:
Name: __________________________________________________________________
Tel number: _____________________________________________________________
Mob number: ____________________________________________________________
