Authorization letter for performing any necessary acts

Authorization letter for performing any necessary acts

 

 

 

 

To whom it may concern,

 

I, ____________, father/mother of ____________, age ____________, authorize ____________ to perform any acts that are necessary to ensure the health of my child while I am away and he/she is under ____________'s care. This includes any doctor/hospital visits, medicine, vaccines, or surgeries. ____________'s medical record number is ____________.
This authorization shall be valid between the dates of ____________ to ____________.

Thank you for your assistance in this matter.

 

Sincerely,

Share   Register