Medical Release Form

Download a blank fillable Medical Release Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Medical Release Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.


I, _____________________________ (Parent/Guardian's Name) hereby give permission
for any and all medical attention to be administered to my
child_________________________ (Child's Name)
In the event of accident, injury, sickness, etc., under the direction of the person(s) listed
below, until such time as I may be contacted.
I also assume the responsibility for the payment of any such treatment.
This release is effective for the period of one year from the date given below.
HOME PHONE: ________________________________________________________
INSURANCE CO.:______________________________________________________
POLICY NUMBER:_____________________________________________________
In case I cannot be reached, any of the following persons is designated to action my
A JGMXT representative where my child is training.
PHYSICIAN: ____________________________________________________________
ADDRESS: _____________________________________________________________
PHONE: _______________________________________________________________
KNOWN ALLERGIES:____________________________________________________
Subscribed and sworn before me, this ______ day of __________________ , 200__
Notary Public


00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal