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MEDICAL RELEASE FORMULAS PERFORMING ARTS Procedure 419-3 A Doctor s Certificate is NOT required. (This form is to be completed by parent/guardian-regardless of your age) STUDENT NAME: AGE: D.O.B.
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How to Fill Out Medical Release Form-LCPS Performing:

01
Begin by providing your personal information, including your full name, address, phone number, and date of birth.
02
Indicate the name of your school or organization (e.g., LCPS Performing) for which the medical release form is being filled out.
03
Specify any medical conditions or allergies you have that need to be known by the staff or medical professionals in case of an emergency.
04
Include the contact information for your primary care physician or healthcare provider.
05
In the event of an emergency, indicate who should be contacted first and provide their contact information.
06
Identify any medications you are currently taking and specify the dosage and frequency.
07
If applicable, provide details about any recent surgeries or medical procedures you have undergone.
08
Sign and date the form to confirm that all the information provided is accurate and complete.

Who Needs Medical Release Form-LCPS Performing:

01
Students participating in LCPS Performing activities, such as performances, rehearsals, or field trips, typically need to submit a medical release form.
02
Parents or legal guardians of students who are minors may need to complete the form on behalf of their child.
03
The form may also be required for adult performers or participants involved in LCPS Performing events, workshops, or competitions.
Note: It is important to check with LCPS Performing or the specific event coordinator to confirm the requirements for submitting a medical release form.
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A medical release form is a document that allows a healthcare provider to share a patient's medical information with another party, usually for treatment or insurance purposes.
The patient or their legal guardian is typically required to file a medical release form.
To fill out a medical release form, you will need to provide your personal information, the purpose of the release, and specify the medical information you are authorizing to be shared.
The purpose of a medical release form is to allow healthcare providers to disclose a patient's medical information to authorized individuals or organizations.
The medical release form should include details such as the patient's name, date of birth, medical history, medications, and the specific information being authorized for release.
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