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EMERGENCY CONTACT / MEDICAL RELEASE FORM 20172018 This form is required annually (to be completed by parent/guardian). It is for official use and will not be released to unauthorized persons. Student:

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How to fill out emergency contact medical release

01

Step 1: Fill out the personal information section with your full name, date of birth, and contact information.

02

Step 2: Provide the name, relationship, and contact information of your emergency contact.

03

Step 3: Include any medical conditions, allergies, or current medications that should be known in case of emergency.

04

Step 4: Sign and date the release form to authorize the release of your medical information to your emergency contact.

05

Step 5: Keep a copy of the completed form with you and provide another copy to your emergency contact.

Who needs emergency contact medical release?

01

Anyone who wants to ensure that their emergency contact can access their medical information in case of an emergency should fill out an emergency contact medical release. This is particularly important for individuals with chronic health conditions, allergies, or those who engage in activities that may pose a higher risk of injury.

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What is emergency contact medical release?

Emergency contact medical release is a document that authorizes medical professionals to contact a designated individual in case of an emergency involving the individual filling out the release form.

Who is required to file emergency contact medical release?

Anyone participating in certain activities or programs that require emergency contact information may be required to file an emergency contact medical release.

How to fill out emergency contact medical release?

To fill out an emergency contact medical release, you will need to provide personal information such as your name, contact information, and the name and contact information of your designated emergency contact.

What is the purpose of emergency contact medical release?

The purpose of emergency contact medical release is to ensure that medical personnel have access to necessary contact information in case of an emergency.

What information must be reported on emergency contact medical release?

Information that must be reported on emergency contact medical release includes the individual's name, contact information, medical history, and the name and contact information of the designated emergency contact.

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