Parental Permission, Medical Consent & Liability Release

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Document allowing parents to grant permission to their child to participate in an activity organized by a school or other group and releases the organizers of the activity from liability.

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A "Parental Permission and Medical Consent with Liability ReleaseĀ Form can be used whenever it becomes necessary for a parent to (a) give permission for their child to participate in an organized activity (i.e. a school trip, scouting trip, sports team etc.?) and (b) release the organizer from liability,

This form allows parents to consent to their child in participating in a specified activity defined on the form. It also grants the organizers of the activity the power to make health care related decisions on behalf of the child. This can be especially important on a school trip if a medical emergency arises when the parents may not be readily available to consent to certain emergency medical procedures.

The Parental Permission and Medical Consent with Liability Release Form also releases the organizers of the event from any liability, holds them harmless and indemnifies them in the event of injury or damage.

This package contains a (1) Parental Permission and Medical Consent with Liability Release Form; (2) Child Care Instructions (3) simple instructions plus a checklist; and (4) additional useful information about Parental Permission and Medical Consent documents.
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.












Parental Permission and Medical
Consent with Liability Release










This Packet Includes:
1. Instructions and Checklist
2. General Information
3. Parental Permission and Medical
    Consent with Liability Release





Instructions and Checklist
Parental Permission and Medical Consent with Liability Release

   Either one or both Parents can sign the Parental Permission and Medical Consent with Liability Release.

   The original Parental Permission and Medical Consent with Liability Release and Child Care Instructions document should be given to the organizers of the activity the child will be participating in.

   The Parents should keep copies of the Parental Permission and Medical Consent with Liability Release and Child Care Instructions document for their records.

   These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first.

    The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at www.findlegalforms.com





General Information
Parental Permission and Medical Consent with Liability Release

It sometimes is necessary for parents to give their permission so that their child can participate in some form of organized activity (i.e. a school trip, excursion, scouting trip, sports team etc…) and to release the organizer of the activity from liability.

A “Parental Permission and Medical Consent with Liability Release” Form allows parents to give consent for their child to participate in a specified activity as defined in the form. This form also grants the organizers of the activity the power to make health care related decisions on behalf of the child.

By having this type of document available, the organizers of the activity will be able to better deal with any types of emergency involving the children and can avoid potential problems when, for example, arranging for medical, dental or any other type of care. This can be especially important on a school or scouting trip if a medical emergency arises when the parents may not be readily available to consent to certain emergency medical procedures. Medical personnel will also generally feel more comfortable dealing with someone who can provide this type of document.

The Permission and Medical Consent with Liability Release Form also releases the organizer of the activity from any liability, holds them harmless and indemnifies them in the event of injury or damage.

Although the Parental Permission and Medical Consent contain a beginning and an “end/expiration” date, the Parent(s) can revoke the document at any time before the ending date.
 
Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific.






DISCLAIMER:

FindLegalForms, Inc. (“FLF”) is not a law firm and does not provide legal advice.  The use of these materials is not a substitute for legal advice. Only an attorney can provide legal advice.  An attorney should be consulted for all serious legal matters.  No Attorney-Client relationship is created by use of these materials.  

THESE MATERIALS ARE PROVIDED “AS-IS.  FLF DOES NOT GIVE ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITY, SUITABILITY OR COMPLETENESS FOR ANY OF THE MATERIALS FOR YOUR PARTICULAR NEEDS.  THE MATERIALS ARE USED AT YOUR OWN RISK.  IN NO EVENT WILL:  I) FLF, ITS AGENTS, PARTNERS, OR AFFILIATES; OR II) THE PROVIDERS, AUTHORS OR PUBLISHERS OF ITS MATERIALS, BE RESPONSIBLE OR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATE OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER USED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THESE MATERIALS. 




PARENTAL PERMISSION AND MEDICAL CONSENT WITH LIABILITY RELEASE


RE:
Name: _________________________________ born on _______________________________
Social Security Number: _________________________________________________________
Address:  _____________________________________________________________________

The undersigned(s) being the lawful parent(s) and/or guardian(s) of the above child (the "Child"), hereby consents to the participation by the Child in ___________________________ (describe activity) conducted by __________________________________________________ (Name of “Organizer") and to the participation of the Child in all events relating to the activity on _______________________________ through ____________________________________.

The undersigned hereby further authorize(s) any of the staff, employees, agents and representatives of Organizer to provide for, approve and authorize any health care at any hospital, emergency room, doctors office or other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose the contents of any medical records; execute any consent form required by medical, dental or other health authorities incident to the provision of medical, surgical or dental care to the child. Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedures.

If there is no medical emergency, the guardian will first use reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatment.

Notwithstanding other provisions in this Consent Form, Organizer shall not have the authority to withhold or withdraw life-sustaining procedures for the Child.

The undersigned assume(s) all risk of injury or harm to the Child associated with participation in the Activity and agree(s) to releases, indemnify, defend and forever discharge the Organizer and its staff, employees and agents (collectively the "Organizer") of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action (collectively the "Claims") in respect of death, injury, loss or damage to the Child or by the Child, howsoever caused, arising or to arise by reason of or during the Child's participation in the Activity.

This Consent Form may be revoked at any time before the expiration date with written notice to Organizer.  

Signed on ________(date), at ____________________ (city),  _____________________ (state).

________________________________
Signature of Parent

________________________________
Signature of Parent

Child Care Information and Instructions

Child's Name:
Child's Nickname:
Child's Age:

Parent(s) and Other Contacts

Mothers Name:
Fathers Name:
Address of Parent(s):
Home#
Work#

Second Contact Name:  
Relationship:
Phone Number:

Third Contact Name:
Relationship:
Phone Number:
  

Medical/Health/Insurance Care Information

Childs Doctor Name:
Address:
Office Telephone:
After Hours Number:  

Health Insurance Company:
Group or Policy Number:
Telephone Number:

Medications:  
Allergies:  
Immunizations:
Special Conditions:





Schedule & Instructions

Meals: __________________________
Snacks: _________________________
Naps:  __________________________
Bedtime:  _______________________
Other:  _________________________

Habits and Rules








Number of Pages4
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#17112
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.












Parental Permission and Medical
Consent with Liability Release










This Packet Includes:
1. Instructions and Checklist
2. General Information
3. Parental Permission and Medical
    Consent with Liability Release





Instructions and Checklist
Parental Permission and Medical Consent with Liability Release

   Either one or both Parents can sign the Parental Permission and Medical Consent with Liability Release.

   The original Parental Permission and Medical Consent with Liability Release and Child Care Instructions document should be given to the organizers of the activity the child will be participating in.

   The Parents should keep copies of the Parental Permission and Medical Consent with Liability Release and Child Care Instructions document for their records.

   These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first.

    The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at www.findlegalforms.com





General Information
Parental Permission and Medical Consent with Liability Release

It sometimes is necessary for parents to give their permission so that their child can participate in some form of organized activity (i.e. a school trip, excursion, scouting trip, sports team etc…) and to release the organizer of the activity from liability.

A “Parental Permission and Medical Consent with Liability Release” Form allows parents to give consent for their child to participate in a specified activity as defined in the form. This form also grants the organizers of the activity the power to make health care related decisions on behalf of the child.

By having this type of document available, the organizers of the activity will be able to better deal with any types of emergency involving the children and can avoid potential problems when, for example, arranging for medical, dental or any other type of care. This can be especially important on a school or scouting trip if a medical emergency arises when the parents may not be readily available to consent to certain emergency medical procedures. Medical personnel will also generally feel more comfortable dealing with someone who can provide this type of document.

The Permission and Medical Consent with Liability Release Form also releases the organizer of the activity from any liability, holds them harmless and indemnifies them in the event of injury or damage.

Although the Parental Permission and Medical Consent contain a beginning and an “end/expiration” date, the Parent(s) can revoke the document at any time before the ending date.
 
Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific.






DISCLAIMER:

FindLegalForms, Inc. (“FLF”) is not a law firm and does not provide legal advice.  The use of these materials is not a substitute for legal advice. Only an attorney can provide legal advice.  An attorney should be consulted for all serious legal matters.  No Attorney-Client relationship is created by use of these materials.  

THESE MATERIALS ARE PROVIDED “AS-IS.  FLF DOES NOT GIVE ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITY, SUITABILITY OR COMPLETENESS FOR ANY OF THE MATERIALS FOR YOUR PARTICULAR NEEDS.  THE MATERIALS ARE USED AT YOUR OWN RISK.  IN NO EVENT WILL:  I) FLF, ITS AGENTS, PARTNERS, OR AFFILIATES; OR II) THE PROVIDERS, AUTHORS OR PUBLISHERS OF ITS MATERIALS, BE RESPONSIBLE OR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATE OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER USED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THESE MATERIALS. 




PARENTAL PERMISSION AND MEDICAL CONSENT WITH LIABILITY RELEASE


RE:
Name: _________________________________ born on _______________________________
Social Security Number: _________________________________________________________
Address:  _____________________________________________________________________

The undersigned(s) being the lawful parent(s) and/or guardian(s) of the above child (the "Child"), hereby consents to the participation by the Child in ___________________________ (describe activity) conducted by __________________________________________________ (Name of “Organizer") and to the participation of the Child in all events relating to the activity on _______________________________ through ____________________________________.

The undersigned hereby further authorize(s) any of the staff, employees, agents and representatives of Organizer to provide for, approve and authorize any health care at any hospital, emergency room, doctors office or other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose the contents of any medical records; execute any consent form required by medical, dental or other health authorities incident to the provision of medical, surgical or dental care to the child. Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedures.

If there is no medical emergency, the guardian will first use reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatment.

Notwithstanding other provisions in this Consent Form, Organizer shall not have the authority to withhold or withdraw life-sustaining procedures for the Child.

The undersigned assume(s) all risk of injury or harm to the Child associated with participation in the Activity and agree(s) to releases, indemnify, defend and forever discharge the Organizer and its staff, employees and agents (collectively the "Organizer") of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action (collectively the "Claims") in respect of death, injury, loss or damage to the Child or by the Child, howsoever caused, arising or to arise by reason of or during the Child's participation in the Activity.

This Consent Form may be revoked at any time before the expiration date with written notice to Organizer.  

Signed on ________(date), at ____________________ (city),  _____________________ (state).

________________________________
Signature of Parent

________________________________
Signature of Parent

Child Care Information and Instructions

Child's Name:
Child's Nickname:
Child's Age:

Parent(s) and Other Contacts

Mothers Name:
Fathers Name:
Address of Parent(s):
Home#
Work#

Second Contact Name:  
Relationship:
Phone Number:

Third Contact Name:
Relationship:
Phone Number:
  

Medical/Health/Insurance Care Information

Childs Doctor Name:
Address:
Office Telephone:
After Hours Number:  

Health Insurance Company:
Group or Policy Number:
Telephone Number:

Medications:  
Allergies:  
Immunizations:
Special Conditions:





Schedule & Instructions

Meals: __________________________
Snacks: _________________________
Naps:  __________________________
Bedtime:  _______________________
Other:  _________________________

Habits and Rules








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