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Permission and Medical Release Form Template

Easily Manage Permissions for Your LDS Activities

Handling permission and medical release forms for church activities can be a hassle, especially when it comes to organization and compliance. This template is designed specifically for leaders and parents involved in the Church of Jesus Christ of Latter Day Saints, ensuring you efficiently gather necessary permissions for youth activities. With features like seamless digital distribution, quick customization options, and compliance-ready fields, you can streamline the process and keep everyone informed, all while ensuring WCAG-aligned accessibility. Explore the live template to simplify your planning today.

Use this Template (FREE) Live Preview
Participant full name
Date of birth
Participant phone
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Parent or guardian full name
Parent or guardian email
Parent or guardian phone
Relationship to participant
Mother
Father
Legal guardian
Self
Other
Please Specify:
Event or program name
Event date
Emergency contact full name
Emergency contact phone
Emergency contact relationship to participant
Parent/Guardian
Spouse/Partner
Family member
Friend
Neighbor
Other
Please Specify:
Primary physician name
Primary physician phone
Medical insurance provider
Policy number
Allergies (check all that apply)
No known allergies
Food allergies
Medication allergies
Insect sting allergies
Environmental allergies
Latex allergy
Other
Please Specify:
Current medications and dosages
Dietary restrictions or other special instructions
Relevant medical conditions (check all that apply)
Please Specify:
Permission for the participant to take part in the above event or program
Yes
No
Consent to emergency medical evaluation and treatment if necessary
Yes
No
Authorization for over-the-counter medications to be administered as labeled if needed
Yes
No
Not applicable
Photo, video, and media release for the participant
Yes
No
I have read and accept the release of liability and assumption of risk as provided by the organizer
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Type full legal name as signature
Signature date
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Paper art illustration depicting a permission and medical release form for a template article on FormCreatorAI

When to use this form

Use this consent and health form when minors join off-site activities, overnighters, sports, or service projects. It protects your organization and gives parents confidence that you can reach them and get care fast. Youth leaders, school staff, scoutmasters, and church coordinators (including LDS wards and stakes) benefit from clear permissions and medical details. Gather participation approval, emergency contacts, allergies, medications, insurance, and treatment consent. Attach the itinerary and note any special risks. For school or community outings, pair it with the Field trip form. For patrol or troop events, check the Boy scouts permission form. Hosting inflatables at a fundraiser or youth night? Add the Bounce house permission slip form to cover that activity. You get complete records, quick sign-off, and fewer day-of surprises.

Must Ask Permission and Medical Release Questions

  1. What is the participant's full legal name and date of birth?

    This confirms identity and age, which affect consent, supervision, and dosing instructions. It prevents mix-ups when multiple participants share similar names.

  2. Which activity are you granting permission for (event name, location, dates, and transportation method)?

    Linking the details to your permission keeps approval clear and limited to the stated event. Listing transport helps parents assess risk and aligns expectations about how their child will travel.

  3. Who is the parent/guardian and how can we reach you during the activity (mobile, email, backup contact)?

    Accurate contact info enables fast decisions in a time-sensitive situation. A backup ensures someone answers if the primary contact is unavailable.

  4. Does the participant have any medical conditions, allergies, or medications? Include dosage, timing, and self-carry permission.

    Knowing conditions, triggers, and meds helps leaders plan and respond safely. Dosage and self-carry notes guide what to bring, who administers it, and how to act in an emergency.

  5. Do you authorize emergency medical treatment if we cannot reach you, and what is your health insurance provider and policy number?

    Treatment authorization lets providers care for the participant without delay when you cannot be reached. For broader liability language, see the Parental consent and release form; insurance details speed admissions and billing.

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