Free Babysitter Medical Release Form Template
Babysitter Medical Release Form
Please fill out this form completely to authorize medical care for your child if necessary, during babysitting services.
Parent/Guardian Information
Name
Phone Number
Child Information
Child's Name
Date of Birth
Allergies or Medical Conditions
Medications (if any)
Emergency Contact Information
Name
Phone Number
Relationship
Medical Release and Consent
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I, the undersigned, authorize [Your Company Name] or its designated babysitter to seek medical care for my child in the event of an emergency when I cannot be reached.
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I consent to the medical treatment deemed necessary by qualified medical personnel, including transport to the nearest hospital or clinic if required.
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I release and discharge [Your Company Name], its employees, and agents from any liability arising from the provision of medical care, except in cases of gross negligence.
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I confirm that all provided medical information is accurate and up to date.
Do you consent to the release as described in this form?
I hereby confirm that all the above information is true and authentic and that I have read, understood, and agree to the terms and conditions.
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