Medical Release Form
Children's Medical release form to participate in activities to be filled out by Parent or Guardian
First Name *
Your answer
Last Name Name *
Your answer
Agreement for Medical Release *
Parents or Guardians- Please check the box, agreeing to the terms.
Required
First Name *
Name of Child
Your answer
Last Name *
Name of Child
Your answer
DOB *
MM
/
DD
/
YYYY
Parent/Guardian Signature:
Please type your name below as a digital signature
First & Last Name *
Your answer
Date of Signature *
MM
/
DD
/
YYYY
Emergency Contact
First & Last Name *
Your answer
Emergency contact number *
Your answer
Submit
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