Minor Emergency Medical Release Form (to be filled out for riders under 18 years of age)Minor Emergency Medical Release Form (to be filled out for riders under 18 years of age) If emergency medical care is required for:______________________________________ in conjunction with Trinity Stable's instruction, rentals, or boarding, and if normal permission is not available in a timely manner, the undersigned authorizes appropriate medical care as deemed necessary by emergency personnel, a physician, or the medical facility providing treatment. Parent/Legal Guardian:___________________________________________________ Address:______________________________ _________________________________________ Phone: Home - (____)_______________ Work - (____)_______________ If parent or Legal Guardian is unavailable, Contact:______________________________ Phone:(____)_______________________________ Relationship:____________________________________ Family Physician:________________________________Phone:(____)_____________ Known Allergies:________________________________________________________ Medications and dosage currently being taken (prescription required if given while at Trinity):_________________________________________________________________ _______________________________________________________________________ Child's Date of Birth:_____________________________________________________ Medical Insurance Company:______________________________________________ Insured Name:_______________________________Policy #:______________________ I have read this release and agree to it: Signed:______________________________Date:_____________________________ Expires December 31 of year signed ************************************************************************ As Parent/Legal Guardian of the above named child, I ask that every effort be made to contact me at the time of illness or injury. I also understand that all minor's under the age of 16 are not allowed at Trinity without a parent or legal guardian present at all times. Additional Comments:______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
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