Child Medical Consent Form

This Child Medical Consent Form is designed to provide consent for medical treatment for a minor child in the absence of a parent or legal guardian.

1. Parent/Guardian Information

Name: [Parent/Guardian Name]

Address: [Parent/Guardian Address]

Phone Number: [Parent/Guardian Phone Number]

2. Child Information

Name: [Child's Name]

Date of Birth: [Child's Date of Birth]

3. Medical Information

Allergies: [List any allergies]

Current Medications: [List any medications]

4. Consent for Treatment

I, the undersigned, hereby give my consent for medical treatment to be administered to my child in the event of an emergency.

5. Emergency Contact

Name: [Emergency Contact Name]

Phone Number: [Emergency Contact Phone Number]

6. Signature

Signature of Parent/Guardian: ______________________

Date: [Date]