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:DateType name Search for: Recent News Now Hiring Executive Director Position January 13, 2025 2024 Newsletter December 10, 2024 Thank you to our Sponsors, Donors, and Supporters! December 27, 2023 Newsletter 2023 December 27, 2023 News Letter 2022 January 24, 2023