Medical And Surgical Consent Form Medical And Surgical Consent Form
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1Medical and Surgical Consent Form
Sport ________Softball________________________________Date _______________
1. As the parent or guardian of ____________________________ I hereby
give my consent to use such treatment as an attending physician or paramedic may deem
necessary in the event of an accident to my child.
2. I hereby give my consent to have him/her sent to the nearest hospital in case of emergency
treatment is necessary. My preference of hospital is ________ hospital if possible.
3. My child has the following allergies: ______________________________
Signature of Parent or Guardian
Address
Phone
Medical and Surgical Consent Form
Sport ______Softball__________________________________Date _______________
4. As the parent or guardian of ____________________________ I hereby
give my consent to use such treatment as an attending physician or paramedic may deem
necessary in the event of an accident to my child.
5. I hereby give my consent to have him/her sent to the nearest hospital in case of emergency
treatment is necessary. My preference of hospital is ________ hospital if possible.
6. My child has the following allergies: ______________________________
Signature of Parent or Guardian
Address
Phone
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