Authorization for Minor's Medical Treatment

Use this form to let an adult authorize medical or dental care for your child. This is helpful when another adult is caring for your child while you are away, or if your child is participating in sports or other organized activity outside of your supervision.

If your child is participating in an activity such as a basketball league or dance lessons, the sponsoring organization will most likely give you its own medical authorization to fill out. If it doesn’t, complete this simple form.

Important to Know

• Without authorization, supervisors may face delays -- or even brick walls -- while trying to help your child get medical attention following an accident.
• This form contains a space for the acknowledgment of a notary public. Practically speaking, a notarized form is likely to be more readily accepted by others.