Medical Release Form Page 2
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1
2MEAL INFORMATION
Number of people who will be attending the Eastern Regional Junior Angus Show
and partaking of the meals:
Breakfast
Lunch
Dinner
*Please complete only one form per family but include all family members, grandparents,
friends, fitters and other guests that may be with you at the show.
MEDICAL RELEASE FORM
In the event of an emergency, I give my permission to allow medical attention administered to
without my notification.
Parent or Guardian
Date
In case of emergency please notify:
Name:
Address:
City:
State:
Zip:
Cell:(
)
Home phone:(
)
Work:(
)
If not available please notify:
Name:
Address:
City:
State:
Zip:
Cell:(
)
Home phone:(
)
Work:(
)
Is the participant allergic to any medication?
If yes, please list.
Does the participant have any existing medical conditions?
If yes, please list.
Is the participant currently taking any medications?
If yes, please list.
List any other existing condition(s), medical or otherwise, the staff should be aware of.
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