Parent Release Form For Medical Treatment

State:
Multi-State
Control #:
US-02450BG
Format:
Word; 
PDF; 
Rich Text
Instant download

Description Release Parent

In most jurisdictions, if a minor suffers injury to his or her person or property, the parent or guardian of the minor may negotiate a settlement of the minor's claim for damages prior to or subsequent to the filing of an action for damages. In order to secure a release of the party or parties allegedly responsible for the injury or loss, the parent or guardian must generally file a verified petition in the court with jurisdiction over minors. The petition shall request approval by the court of the terms of the proposed settlement, the release of liability and the manner of distribution of settlement proceeds. The petition generally is required to state such matters as:

•The name, gender and age of the minor;
•The facts of the injury and damages of the minor relied upon in requesting the court to consider and approve the proposed settlement and release;
•The circumstances and events leading to the injury or loss at issue and the identities of the persons or entities alleged to be responsible for the injury or loss;
•The identities of the persons or entities to be released;
•The circumstances of the minor at the time of the petition or motion;
•The relationship of the petitioner or moving party to the minor;
•A proposal for distribution of other settlement proceeds; and
•A request for such other relief as the court may determine is appropriate in the best interests of the child.

This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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Release Injuries Accident