Plan on typing up the form and having it signed by all parties within a week or two of the expected travel date. Understand that only the parent or guardian has the authorization to agree to medical care for the child. Keep the wording simple and straightforward, so there is no question what the form is for. Title the form "Medical Consent Form."
Begin with the following: "In case of emergency, (adult who child is traveling with), has my consent to authorize all medical and/or surgical treatment for my child or children listed below." List the first and last name of the children who will be traveling. List the birth date of each child as well.
Include the name of the family physician, along with their contact information. Include the preferred hospital if the child will be traveling locally. List any allergies the child may have or state that the child has no allergies. Provide the date of the child's last tetanus immunization. List the child's social security number if you want. Include the parent or guardian's contact information.
Add in any specific instructions like religious boundaries, blood type, health problems or current medications.
Provide a space at the bottom of the release form that includes secondary contact information. List 2 to 3 people who can be contacted in case of an emergency if the parent or guardian cannot be reached.
Include a signature line at the end of the release form. Provide a space for the parent or guardian's signature, along with contact phone numbers, address and date. Take the form to the nearest notary and have the parent or guardian sign it in the presence of a notary public.
