Medical Consent/Hold HarmlessMedical Consent/Hold Harmless Agreement • January 13th, 2018
Contract Type FiledJanuary 13th, 2018We, the Parents of , give permission for emergency medical treatment of our child for illness or accident if we cannot first be contacted. Emergency Parent or Guardian: Name: Phone: Office: Mobile: Email: Emergency Secondary Contact: (other than parent) Name: Phone: Office: Mobile: Email: Relationship: Does your child have any allergies or require special medication: Yes: No: Explanation: