Emergency Release Form

Participant Full Name*

Date of Birth*

Parent / Guardian Name (if minor)

Emergency Phone Number*

Known Allergies or Medical Conditions

I authorize emergency medical treatment if I am unable to give consent at the time*

I release the organization from liability for emergency actions taken in good faith*

Signature*

Signature field

Date*

What is this form?

An emergency release form authorizing emergency medical treatment and releasing care providers from liability. Used for events, camps, schools, and travel programs.

Who is it for?

Event organizers, schools, camps, travel companies, and parents authorizing emergency care.