Emergency Release Form Sample Contracts
EMERGENCY RELEASE FORM All questions must be answered & sent with payment.Emergency Release Form • May 14th, 2009
THE AGE OF 18 YEARS OF AGE) , I understand that every effort will be made to contact other parent/guardian/alternate person. In the event I or they cannot be reached, I hereby give permission to the physician selected by the program to hospitalize, to secure proper treatment for, and to order injection, anesthesia, surgery or other medical procedure necessary for me / my child.