Texas Medical Release Form For Minor Child
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I, the undersigned parent or guardian of ___________________________, a minor, do hereby authorize Texas Bahá’í
School, or its designated representative, agent(s) for the undersigned, to consent to any x-ray examination, anesthetic,
medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is rendered under the
general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act
on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said
physician or at said hospital. As the parent/guardian of a minor under the age of 18, I understand that this authorization
enables Texas Bahá’í School to arrange medical care for my dependant minor in the event I am unavailable.
I understand that I am responsible for payment of any and all medical expenses incurred on behalf of my dependent
minor. This authorization shall