La Scuola Authorization Of Temporary Guardianship Page 3
Download a blank fillable La Scuola Authorization Of Temporary Guardianship in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete La Scuola Authorization Of Temporary Guardianship with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
44.
I authorize the Temporary Guardian, in the event that I cannot be contacted or if any urgency
dictates, to act in loco parentis for the Child in respect of any circumstances, including any accident or
illness, which may necessitate medical treatment, including surgery, and on my behalf to authorize any
such treatment or surgery which they, in their sole discretion, (which discretion shall not be unreasonably
exercised), may deem necessary. Medical treatment for the Child may also include dental surgery, x-ray,
blood transfusion, anesthetic and medication provided any such medical treatment is performed by a duly
licensed practitioner. I hereby accept full liability for all costs incurred through such medical treatment for
the Child.
5.
Persons responsible should please note the following: (Please state aspects eg. allergies, tendency
towards abnormal bleeding, epilepsy, etc.)
Present prescribed, or other medication that is being administered:
6.
The following information is essential in case of medical treatment or hospitalization:
6.1.
Name and Address of Employer:
6.2.
Medical Aid / Insurer:
6.2.
Policy Number:
7.
I indemnify the Temporary Guardian against any and all claims whatsoever and howsoever arising,
save where such claims arise from negligence, gross negligence or willful intent during the specified
period of Temporary Guardianship.
8.
I declare that I am the legal custodian of the Child and that I have legal authority to appoint a
Temporary Guardian for the Child.
9.
Unless inconsistent with the context, words signifying the singular shall include the plural and vice
versa.
Page 3 of 4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal