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APPENDIX N CHAPERON FORM AND EMERGENCY MEDICAL AUTHORIZATION FORM (SEE SECTION 16) Appointment of Chaperon To: (Name of Engaged) Re: (Name of Production) I, (Name of Parent), am the Parent or legal
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How to fill out actra medical release forms

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How to fill out ACTRA medical release forms:

01
Obtain the ACTRA medical release forms from the official ACTRA website or request them from your local ACTRA office.
02
Carefully read the instructions provided on the form to understand the information required.
03
Fill in your personal details including your name, contact information, and ACTRA membership number, if applicable.
04
Provide a detailed medical history by answering the questions regarding any past or current medical conditions, surgeries, allergies, medications, and treatments.
05
Make sure to accurately document any known medications you are taking, including the dosage and frequency.
06
If you have any medical records, attach them to the form or include relevant details such as the dates of medical visits and the names of healthcare providers you have consulted in the past.
07
Sign and date the form, verifying that the information provided is true and accurate to the best of your knowledge.
08
Keep a copy of the completed form for your records and submit the original form to the designated ACTRA representative or office.

Who needs ACTRA medical release forms:

01
ACTRA members who are actively involved in the entertainment industry and require medical information to ensure their safety during performances or productions.
02
Actors, performers, and other professionals working in the film, television, and theatrical industries who are either joining ACTRA or need to update their medical information.
03
ACTRA-affiliated production companies or casting directors who require access to the medical records and consent of performers for specific projects or as part of their contractual obligations.
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Actra medical release forms are documents that authorize the release of medical information to Actra, the Alliance of Canadian Cinema, Television and Radio Artists. These forms allow Actra to access an individual's medical records and information for the purpose of determining eligibility for certain benefits or services.
Any individual who is a member of Actra and wishes to receive specific benefits or services that require access to their medical information is required to file actra medical release forms.
To fill out actra medical release forms, individuals need to provide their personal information, including their full name, contact details, and Actra member identification number. They also need to indicate the specific benefits or services they are seeking and sign the release form to authorize the disclosure of their medical information.
The purpose of actra medical release forms is to allow Actra to access an individual's medical records and information for the purpose of determining their eligibility for specific benefits or services. This helps Actra ensure that their members receive the appropriate support and resources based on their medical needs.
Actra medical release forms typically require individuals to report their personal information, such as their full name, contact details, and Actra member identification number. Additionally, they may need to specify the specific benefits or services they are seeking that require access to their medical information.
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