CONSENT FOR MEDICAL TREATMENT

Narragansett Bay Yachting Association
CONSENT FOR MEDICAL TREATMENT (Minor)

As the parent or legal guardian of the below listed child, I hereby give my consent for the medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my dependent.
SAILOR FULL NAME *

First Name Last Name
Parent or Guardian Name *

First Name Last Name
Parent or Guardian Name

First Name Last Name
PRIMARY Phone Number *

Area Code Phone Number
CELLULAR

Area Code Phone Number

Address *

Narragansett Bay Yachting Association