Get Brandeis University Parent/guardian Permission Release & Medical Authorization Form 2019-2025

Completing the Brandeis University Parent/Guardian Permission Release & Medical Authorization Form is an important step for parents or guardians wishing to permit their child to participate in the overnight visit program. This guide will walk you through the process of filling out the form online, ensuring all required information is correctly provided.

Follow the steps to fill out the form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering your child's legal name, school name, and their address in the designated fields. Ensure that the date of birth, city, state, and zip code are also filled out correctly.
3. Select the gender of your child by choosing the appropriate option from the provided options: Female, Male, or Other.
4. Provide your child's cellular number and email address to facilitate communication.
5. In the next section, indicate your child's ethnicity or ethnicities if you wish, as this is an optional field.
6. Detail any special medical restrictions or allergies that your child may have to ensure their safety during the visit.
7. Fill out your primary doctor's name along with their phone number to provide necessary medical contacts.
8. Complete the insurance information fields, including the insurance company name, policy number, and insurance phone number. Ensure you specify the name of the policyholder.
9. Provide your name as the parent or guardian along with your home and cellular phone numbers. Include your address, email address, and an emergency contact number.
10. Read through the release statement carefully and sign where indicated. Be sure to date your signature as well as your child’s signature.
11. If desired, fill out the photo permission and sharing student information sections to allow Brandeis University to share details with hosts or to capture photos during the event.
12. Once all sections are completed, review the form for any errors or missing information before saving your changes. Then you can download, print, or share the completed form as necessary.

Complete and submit the Brandeis University Parent/Guardian Permission Release & Medical Authorization Form online today to ensure your child's participation.