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Arizona soccer association medical release form

ASA-ADM-Form-01 0004-2025

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4.6 out of 5

36 votes

The document is a medical authorization form for the parent or legal guardian of a minor, allowing for medical treatment and procedures in their absence. It grants permission to healthcare professionals to provide necessary care, including diagnostics and treatments, and includes sections for personal information, known allergies, and emergency contacts. Additionally, it requires notarization and specifies that it expires one year from the date of notarization or at the end of the next playing season.

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Click ‘Get Form’ to open ASA-ADM-Form-01 0004 in the editor.
Begin by entering the name of the player in the designated field. Ensure accuracy as this information is crucial for medical purposes.
Fill in the date of birth and date of last tetanus booster. Use the format provided (MONTH/DAY/YEAR) for consistency.
List any known allergies, including medication allergies, in the appropriate section. This is vital for ensuring safe medical treatment.
Provide details about any other medical problems that should be noted, along with the family physician's name and contact number.
Complete the parent/legal guardian's information, including address and telephone numbers for both work and home.
If applicable, fill out the person responsible for charges and their contact information.
Designate a person to notify if you are unavailable, along with their phone number.
Finally, review all entries for accuracy before signing at the bottom. Ensure you also complete the notary section if required.

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Versions	Form popularity	Fillable & printable
2022	4.6 Satisfied (36 Votes)
2017	3.8 Satisfied (32 Votes)
2008	4 Satisfied (40 Votes)

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