Medical Release form

Please fill out the information below and submit.

Medical Release Form

  • I hereby give consent for a qualified physician or surgeon to examine, diagnose, prescribe, and perform treatment (including surgery) which is deemed advisable for the welfare of:
    Note: Medications will not be given under any circumstances without prior written permission from parent /guardian. No student is permitted to have prescription or non-prescription on his/her person at any time.
  • MM slash DD slash YYYY
  • Medical History

  • MM slash DD slash YYYY
  • Insurance Information

  • MM slash DD slash YYYY
  • Drop files here or
    Accepted file types: jpg, png, pdf, Max. file size: 64 MB.
      Please include front and back.

    If you prefer to download the Medical Release form: