Home > Life > Medical Forms > Medical Release Template > Georgia Medical Release Form > Georgia Medical Release Form 2

Georgia Medical Release Form 2

At Speedy Template, You can download Georgia Medical Release Form 2 . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.
This form is provided by Georgia Gymnastics Academy for the medical information release regarding the medical care and treatment necessary to be administered to the student.

Georgia Medical Release Form 2
Georgia Medical Release Form 2
GEORGIA GYMNASTICS ACADEMY
MEDICAL RELEASE FORM
Student’s Name:__________________________DOB:_______Age:______
Home Phone:(___)____-________________Cell Phone:(___)____-____________
Address:___________________________________________________________
City:__________________________________State:_______Zip:_____________
Mother’s Name:______________________Father’s Name:__________________
Fill out the following information so we may contact you quickly in the
event of an emergency: Who to call if parents cannot be reached:
Name/Relation:_________________________________ Phone #:(___)___-_________
Child’s Doctor’s Name:___________________________ Phone #: (____)___-______
Medical Insurance Company: ______________________Policy #_________________
Any intolerance/allergy to drugs or medications_____________________________
Please elaborate:________________________________________________________
Does the child have any medical conditions we should be aware of_________
Please elaborate:_______________________________________________________
ACKNOWLEDGEMENT OF RISK, WAIVER OF LIABILITY AND MEDICAL RELEASE:
As parent/legal guardian of______________________, I hereby consent to the above person participating in the GEORGIA
GYMNASTICS ACADEMY, Inc.’s programs. I recognize that potentially severe injuries, including permanent paralysis or
death can occur in any activity involving height or motion, including gymnastics. I also realize that my child will be
performing and training on all gymnastics events plus various other training devices including trampoline.
I understand that is the express intent of GEORGIA GYMNASTICS ACADEMY, INC. to provide for the safety and
protection of my child and, in consideration for allowing my child to use these facilities, I hereby release GEORGIA
GYMNASTICS ACADEMY, INC., it’s officers, employees, teachers, and coaches from all liability for any and all damages
and injuries suffered by my child while under the instruction, supervision or control of GEORGIA GYMNASTICS
ACADEMY, INC.
I specifically appoint GEORGIA GYMNASTICS ACADEMY, INC. to authorize emergency medical treatment for my child
____________________, to execute consent orders or other documents for any medical procedure which is required to save the
life of ______________________, or to prevent a deterioration of any existing or new medical condition, or to stabilize any
medical condition which may or may not deteriorate, as fully as I could if I were present. This acknowledgement of risk,
waiver of liability, and medical release having been read thoroughly and understood completely, is signed voluntarily as to it’s
content and intend.
Parent or Legal Guardian’s Signature:__________________________________________Date:________________
Georgia Medical Release Form 2