Youth Medical Treatment Form

Youth Permission Form

Name of Child(Required)
MM slash DD slash YYYY
Name of Parent/Guardian(Required)
Name of Parent/Guardian
Address(Required)
Emergency Contact Information(Required)
Please provide any and all information regarding special circumstances, medical history, allergies, penicillin or drug reactions, etc., while on event and which caretakers and/or providers should be aware about.
Permission to Treat My Child(Required)
Type your name as an electronic signature.
MM slash DD slash YYYY