If you’re going to leave your child in the care of another adult, you should give that person permission to authorize medical care and make other important decisions on your child’s behalf.  This includes school-related decisions such as permission for a field trip, or who can pick up your child if he or she becomes ill. 

Use this form to establish a temporary “informal guardianship,” which is different from a formal, court-approved guardianship. 

Important to Know:

• While this form will give an adult permission to authorize medical treatment to your child, you should consider using "Authorization for Minor's Medical Treatment" as well, because it lets you cover your child's medical needs and history in depth.

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, but notarization isn’t always necessary.