Sample Child Guardian Consent Form, Medical Authorization For Minors & Minors' Consent To Participate And Hold Harmless Agreement printable pdf download

Sample Child Guardian Consent Form, Medical Authorization For Minors & Minors' Consent To Participate And Hold Harmless Agreement

CHILD GUARDIAN CONSENT FORM

I ____________________ of _________________________________, the current legal parent of

(child's parent) (parent's city & state)

_______________________ born on ___________________________________, hereby appoint

(child's name) (child's date of birth)

_____________________ of _________________________________ as legal guardian for my child

(guardian's name) (guardian's city and state)

for the period of time beginning on ___________________ and ending on ____________________.

The guardian shall have the right to:

1. Determine and authorize necessary medical attention.

2. Provide necessary clothing, food, and shelter.

3. Generally act in loco parentis.

Executed this ________ day of ____________________, ________

____________________________________

(Parent's Signature)

State of ______________________

County of ______________________

On this ______ day of ____________________, _____, before me, the undersigned, a Notary Public in and for the

State and County mentioned above, personally appeared __________________________, known to me or

satisfactorily proven to be the person who executed the foregoing instrument, and who have acknowledged the

execution of the same.

Subscribed and sworn to before me this _____ day of _________________,______.

My Commission Expires:

_____________________________

_____________________

NOTARY PUBLIC

Sample Child Guardian Consent Form, Medical Authorization For Minors & Minors' Consent To Participate And Hold Harmless Agreement