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Medical Treatment Authorization for a Minor

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Sample Medical Treatment Authorization for a Minor Form Template
Medical Treatment Authorization for a Minor Basics

This authorization is used by a parent to authorize a child care provider, parent, or other responsible person to obtain medical treatment for a child.

Use the Medical Treatment Authorization for a Minor document if:

  • You want to grant medical authorization to a person having temporary responsibility for your child.
  • You want to state the amount of authorization and to provide medical and contact information.
  • You or your child are taking a trip or will be separated for some other reason and the person responsible for your child needs authority to seek medical treatment.

Medical Treatment Authorization for a Minor


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