Medical Release Form
Sign in to Google to save your progress. Learn more
Email *
TVA reserves the right to have your child transported by ambulance or school official to the nearest hospital or medical facility to obtain medical treatment authorized by the Board of Health in case of an accident or serious illness. In case of accident or serious illness, if the school is unable to contact me or the other authorized person, I hereby authorize the school to take my child to the aforementioned physician or a hospital authorized by the Board of Health. I hereby give permission for my child to receive emergency medical care. Information on this document may be made available to school and Health Department Officials.
Student First & Last Name:
*
Grade: *
If I am unable to be contacted, I hereby authorize the school to take my child to the aforementioned physician or a hospital authorized by the Board of Health. I hereby give permission for my child to receive emergency medical care. (Please type your name below) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of TVA-EMAIL. Report Abuse