Printable Business Form Templates
Medical Release Form For Minor Business Form Template

Medical Release Form

In case of emergency, I grant consent to {name} to authorize medical care for my minor child/children:

Our family doctor is: ____________________________

The hospital we use is: ____________________________


Contact me immediately at: ____________________________

Alternative contact name and number: ____________________________

Signature: ____________________________

Name: ____________________________

Address: ____________________________

Phone: ____________________________

Date: ________________

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