Use a Medical Release Form so Your Kids Can Receive Treatment

Young girl with broken wrist
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    Printable Medical Release Form

    Free printable medical release form
    Use this printable medical release form to ensure your child's medical care in the event of an emergency. © Jennifer Wolf, 2006, licensed to

    Most of the time, kids' accidents and emergencies are entirely unpredictable, unplanned, and unexpected and they can catch caregivers off guard, too! That's why you need to print copies of this free medical release form, so you can give clear, irrefutable consent for medical treatment—even if you cannot be reached by phone, text, or email in the event that your child suffers an injury that requires medical treatment.

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    Why You Need a Medical Release Form

    Many urgent care facilities and emergency rooms will not treat minor children unless:

    • A parent is present
    • A parent has given consent, in writing, or
    • The child's life is in danger

    But what about injuries that aren't life-threatening. Say your child suffers a broken bone on the playground while you're at work or out of town. You don't want your child to have to wait for treatment—including pain relievers—until you can be reached. 

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    How to Fill Out This Medical Release Form

    1. Start by printing both pages of the medical release form.
    2. Fill out the form completely. Be sure to include your ex's contact information, if he or she shares custody or parenting responsibilities.
    3. Repeat steps 1 and 2 for each child.

    Note: The form is in PDF format. You can download Adobe Acrobat Reader if your computer is not configured to read PDF documents.

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    How to Ensure That the Medical Release Form Is Accurate and Legal

    Medical Release Consent Form in a Backpack
    Tip: Keep a copy of this medical release form in your child's backpack. Image © Jennifer Wolf, licensed to

    There are a few additional steps to take to be sure your child has access to healthcare. Be sure to:

    • Verify all of the phone numbers.
    • Include primary and secondary insurance information.
    • Have the form notarized at a notary public. (Note: Do not sign any copies of your kid's medical consent forms until you're in the presence of the notary! Signing them too early will nullify the entire process, and you'll have to start over.)
    • If you share legal custody with your ex, make arrangements to...MORE have the form notarized together so that you can both sign it. This is the best way to indicate that you both give consent for your child to receive treatment in the event that neither of you can be reached in an emergency.
    • Consider having multiple copies notarized for each child.
    • Keep notarized copies (not photocopies of the original) at home, at your ex's home, in your child's backpack, and anywhere your child frequents on a regular basis (such as a babysitter's house).
    • Review the forms annually. If key information has changed, print new copies and start over. It's vitally important that all of the information be accurate and up-to-date!