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Medical Release Form for Minors Attending With A Guardian Name of Minor Child Age Date of Birth We the undersigned parent s or legal guardian s of the above-named minor know that I may not be available to authorize medical care of said minor child and I wish to appoint someone to act in my place in my absence and to give such authorization. This authorization is intended to give name of guardian over 18 the right to give consent to authorize emergency medical care. It is the intent that the...
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Who needs the Medical release for Minors form?

Parents or guardians who want to authorize another party (such as a temporary guardian) to legally consent to their child’s medical treatment.

What is the Medical release for Minors form for?

A Medical Release form should be used by parents or guardians who may be unable to personally consent to their child's medical treatment due to travel or other situations where the children will be without parental care.

Is the Medical Release for Minors accompanied by other forms?

If the Medical Release for Minors is being used for travel purposes, it is often accompanied by a Child Travel Consent form that grants the child the right to travel alone or with an authorized guardian. Often, both documents are used in order to demonstrate that your child is travelling with a fit caretaker.

When is the Emergency Medical release due?

There is no precise term of validity for this form. It should be used as needed.

How do I fill out Emergency Medical release form?

The Emergency Medical Release form is self-explanatory. It will ask for information such as:

  • The names and addresses of the parent(s) or guardian(s) who are providing the authorization;

  • The names and birthdates of all children involved

  • Health information for each child involved, such as immunization records and allergies;

  • The identity of the temporary guardian

  • A description of the medical treatments for which authorization is provided

  • A statement that there is no court orders that would prevent the parent or guardian from legally making such an authorization; and

  • Signatures of the parent(s) or guardian(s) in the presence of 2 witnesses and a notary public.

Where do I send the Medical Release form?

The filled out and signed Medical Release form should be carried by the temporary caregiver and child upon travel or as needed.

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