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  • Key Club Medical Release Form

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Authorization to Attend and Medical Authorization Medical Authorization Reset Form Upon completion, this form must be held by chaperone Do not send to the Kiwanis District Office Print Form Authorization.

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How to fill out the Key Club Medical Release Form online

Filling out the Key Club Medical Release Form is an essential step to ensure that your child can safely participate in events. This guide provides clear instructions for completing the form online with ease and accuracy.

Follow the steps to complete the form accurately.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by filling out the member's name in the designated field. Ensure that the spelling is correct, as this will be used throughout the form.
  3. Enter the name of the chaperone responsible for the member. This should also include the chaperone's relationship to the member.
  4. Provide the chaperone's address, including city, state, and zip code. Ensure that this information is accurate for emergency contact purposes.
  5. Indicate the sex and birthdate of the member. This information is essential for identification in case of emergencies.
  6. Fill in the emergency contact information, including daytime and nighttime phone numbers. It's also important to list an alternate contact with their relationship to the member.
  7. Complete the medical information section by providing the name of the health insurance company, policy number, group name, and contact details from the insurance card.
  8. Indicate whether the member will be taking any prescription medication or over-the-counter drugs, and provide details if the answer is yes.
  9. Answer the medical history questions regarding treatments for various conditions. Be thorough and accurate to ensure the safety of the member.
  10. Review the consent section carefully. Confirm understanding and provide your signature as the parent or legal guardian, ensuring all information provided is correct.
  11. After completing the form, you can save changes, download, print, or share the form as necessary.

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