Medical Treatment Parent Consent Form
Child Information
Full Name
Date of Birth
Allergies / Medical Conditions
Parent / Guardian Information
Full Name
Relationship to Child
Phone Number
Alternate Phone
Email Address
Emergency Contact
Name
Relationship
Phone Number
Consent
I hereby give permission for medical treatment of my child as deemed necessary by medical professionals. I also authorize the release of relevant medical information in the event of an emergency.
Parent/Guardian Signature
Date