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Permission for medical treatment

Intro

Most martial art schools will require a student to sign a permission for medical treatment form. This gives qualified personnel permission to perform emergency treatment as necessary.

Sample permission for medical treatment form

I, __, hereby give my permission, consent, and authorization for any medical treatment deemed necessary by a hospital or physician. I appoint ___ my lawful agent with power to authorize and consent to the administration of medical treatment during the aforementioned training or competition.

Home phone:
Alternate Phone:
Health insurance carrier:
Other emergency contacts:
List all allergies, restrictions or health exceptions:

In the case of such accident or illness, I give permission for medical treatment to be given to me as deemed appropriate. I will assume responsibility for any medical treatment as deemed appropriate. I will assume responsibility for any medical bills incurred on my behalf.

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