ADVICE
I never travel with kids any where unless they have a completed and signed medical release form. It saved me a major headache several years ago at a Junior Beta Convention. If you travel use one! The form below was adapted from a legal form developed by the National Youth Sports Coaches Association. Believe me, at convention that year, a young student got sick and the hospital was hesitant to do anything until her parents arrived (over 2 hours later). I showed the hospital staff this form and no questions were asked from that point on. She stayed in the hospital for nearly two weeks.
Medical Information
Name _________________________________________Date of Birth _______________
Home Address _____________________________________City____________________
State__________________ Zip_______________
Home Telephone (______) _________________________________
Parent/Guardian Mother ________________________________phone(____)__________
Father_____________________________________phone(____)_________________
Physician's name __________________________________phone(____)___________
If parents cannot be reached, contact:_________________phone(____)___________
List important medical information and or health problems, allergies,etc.___________
____________________________________________________________________________
Medical Insurance Company Name ____________________________________
Policy or Group ________________________Verification of Benefits(____)__________
Name of Insured __________________________ Relationship to Student_________
___________________________________ ________________________________
Minor - Patient Parent/ Guardian
Date _________________________________
State of Louisiana, Parish of Calcasieu
