Form 2: Medical Release – Primary Players

Medical Release OPTIONAL

Medical information requested in this form is not required for participation with Primary Players. We DO need this form signed by a parent, however. If you decide not to share this medical information, please sign a blank Medical Release form at rehearsal.

Student Name*
First Middle Last
Emergency Contact:*
Relationship
Phone
Allergies
Current Medications
Previous Surgeries
Insurance Carrier*
Family Doctor*
Employer
Employer's Address
Street Address Address Line 2 City State ZIP Code
I hereby authorize Primary Players Children's Theatre Group to call 9-1-1 or to arrange for transportation to the nearest hospital in the event of a major injury.*
- I Agree
Parent Signature

By typing your name here, you authorize the above information to be correct.
Name
This field is for validation purposes and should be left unchanged.

Medical Release *OPTIONAL*

Medical Release OPTIONAL