North Carolina Medical Release Form 2
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North Carolina High School Honors Chorus Medical Release Form
I, the parent/guardian of __________________________________give my permission to the
coordinator of the NC Allstate Chorus to act as guardian, if I cannot be contacted in the event of
accident or medical emergency involving my child. Also, in the event of emergency, she has my
permission to obtain medical treatment for the proper care and well-being of my child.
_____________________________________________________Parent/guardian signature
Date_____________________________School (name in full)__________________________________
Teacher______________________________________________________________________________
Please list any known allergies or medical conditions we need to be aware of:_______________________
_____________________________________________________________________________________
Please list any medications you child is currently taking regularly________________________________
_______________________________