<p> Huffman ISD Fine Art Medical Release Form</p><p>Student: ______</p><p>Parents: ______</p><p>Address: ______</p><p>Day phone#: ______Night phone#: ______</p><p>Cell Phone#: ______</p><p>Emergency contact if the parent or legal guardian is not available: Name: ______Relationship: ______Phone #: ______</p><p>Medical Information: Doctor’s Name: ______Address and phone # of above: ______Insurance Company: ______Policy # - Group #: ______Allergies: ______Medical Conditions: ______Past Injuries, etc..: ______</p><p>I, the Undersigned, hereby authorize emergency medical treatment of such minor when I cannot be contacted to so consent. Such medical treatment may include administration of tests, drugs, X-ray, examinations, anesthetics, dental or surgical examinations or treatment and general hospital care as necessary. Permission is also given to dispense over-the-counter medications necessary for minor illness and First Aid. (Tylenol, Advil, Neosporin, antihistamines, decongestants, etc.) Please list additional medical concerns below, which may include allergies or diet restrictions that should be noted prior to treatment: ______</p><p>______Parent Signature Date</p>