Medical Treatment Release Form
Zion Lutheran School 2025-2026 School Year
STUDENT:
First Name
Last Name
(Please choose option 1 BEFORE
OR
2 WHILE below)
1. If my child needs medical attention while under school supervision it is my wish that I be contacted BEFORE any medical procedures are taken on my child, unless immediate treatment is necessary to save my child's life or to prevent permanent injury.
BEFORE
Signature
PARENT/GUARDIAN (sign and date)
OR
2. If my child needs medical attention while under school supervision it is my wish that the treatment be started WHILE efforts are being made to contact me so treatment is not delayed. I consent to any medical procedures that the physician believes are needed with the understanding that the efforts to contact me will continue to be made. I accept responsibility for all costs related to such treatments.
WHILE
Signature
PARENT/GUARDIAN (sign and date)
Contact Information:
FATHER:
MOTHER:
Any additional information we need in order to contact parent:
Name
First Name
Last Name
Submit
Should be Empty: