Medical Treatment Authorization Form

  • This form grants temporary authority to the Tucson Youth Music Center and its representatives to arrange for and authorize emergency medical care for a minor in the event that minor is not accompanied by parents or legal guardians or other person(s) designated by the parents and it is not feasible or practical to contact any of them in a timely fashion.
  • MM slash DD slash YYYY
  • Information For Medical Treatment

  • AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S)

  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.