Colorado Adult Authorization Medical Release Form Preview
**A SEPARATE FORM IS REQUIRED FOR EACH ADULT ATTENDING STATE AUTHORIZED ACTIVITIES
**A SEPARATE FORM IS REQUIRED FOR EACH ADULTATTENDING STATE AUTHORIZED ACTIVITIES. Duplicate
ADULT AUTHORIZATION MEDICAL RELEASE
NAME OF ORGANIZATION
I,() (Signature of adviser, teacher or parent/guest) (Social Security #)
hereby authorize in advance any necessary medical treatment required for me. I am presently under medical care.YesNo
If yes, explain:
Medical Insurance Co.Policy #
Name of Insured
Name of Family Physician
Any allergies, medications, etc.
I agree not to hold the Colorado Career and Technical Student Organizations, the State Board for Community Colleges of Colorado, or any of its agents, liable for any accident, illness, or injury to me during participation in any state authorized activity, including travel to and from activity sites.
This release is for all local, district, state and national CTSO activities for the currentschool year beginning August 1 and ending July 31.
Colorado Adult Authorization Medical Release Form Thumbnail Preview