2026 FIRST AID MINOR CONSENT FORM

THIS FORM MUST BE COMPLETED FOR EACH CHILD, AGE 0-18 YEARS.
FIRST-AID CLINIC MINOR CONSENT FORM
Consent to Treat Minor Patient-Without Parent/Legal Guardian Present
By law, any child under the age of 18 years old cannot be seen by a nurse/doctor without consent from a parent or legal guardian.
Minor's name:
AGE:
DOB:
GRADE:
For those occasions when you may not be with your child, please list those individuals who may give us consent to see your child:
Name
Relationship to Child
Phone Number
Name
Relationship to Child
Phone Number
Name
Relationship to Child
Phone Number
It is always recommended that a consenting adult accompany a minor when receiving medical care but in the event of an emergency, consent may be given to provide 1^st aid or emergency care to the minor child.
ALLERGIES:
Check here if you wish to give consent for the minor to receive medical care without an accompanying adult
This consent shall be in effect for the following dates: Date: July 27-30, 2026
AUTHORIZATION:
I (parent/legal guardian name)
Phone:
Request and authorize The First Aid Clinic at Family Camp and its personnel to deliver first-aid medical care to my child listed above as may be deemed necessary or advisable in the diagnosis and treatment of the minor child. I have read, understand, and give my consent as stipulated above. My signature means that I have read this form and understand this form.
Parent or Legal Guardian (please print)
Relationship
Parent or Legal Guardian Signature

Clear
Date

MonthDayYear
Date
IF FOR SOME REASON THIS FORM WON'T SUBMIT BELOW, PLEASE MAIL COMPLETED FORM TO: P.O. BOX 39, HILLSBORO, OH 45133; OR SCAN/EMAIL TO P2PM_OFFICE@YAHOO.COM
Should be Empty:

THIS FORM MUST BE COMPLETED FOR EACH CHILD, AGE 0-18 YEARS.

FIRST-AID CLINIC MINOR CONSENT FORM

AUTHORIZATION: