Home » Enroll a Child » Child Enrollment Forms » Kinship Medical Release Form Kinship Medical Release Form Kinship Medical ReleaseFor the safety of my child: First Last I hereby authorize my child’s mentor: First Last Kinship staff or any other volunteer with Kinship of the Park Rapids Area to secure emergency medical attention for my child, in the event that I cannot be contacted.Our local doctor: First Last At (name of clinic): Clinic phone number:has my permission to release any records that may be needed to treat my child in an emergency.For emergency purposes, I can be reached at:Select OneHomeWorkOtherHome Phone:Work Phone:Other Phone:My closest friend/relative is: First Last Phone number:Relationship: Allergies my child has:Regular medication my child receives:Phobias or fears my child has:Any other important medical information:If you are on Medical Assistance or have insurance or an HMO, please give policy name and number to be used: Signature:Date Type name Search for: Recent News News Letter 2022 January 24, 2023 Mentor Nationals Guide to Becoming a Better Mentor December 13, 2022 You Can Mentor (Podcasts) December 11, 2020 Champions For Change June 4, 2020 The kids aren’t all right: Why mentees will be disproportionately affected by the pandemic April 30, 2020