Authorize another adult caring for your child to consent to medical or dental care within the stated scope. You are arranging written care permissions while a child is with another adult.
You are arranging written care permissions while a child is with another adult.
People reviewing the supplied packet with the receiving organization or a licensed California attorney.
People who want to read the packet's instructions before arranging signatures and witnesses.
What you'll need
Parent, child and authorized caregiver details.
The care permissions, relevant dates and provider requirements.
Acceptable identification if a notarial appointment is required.
How to complete it
Download the original PDF to your device and read the instruction pages before entering information.
Review the packet's scope and any provider-specific requirements before completing the permissions and dates.
Complete the applicable fields in a PDF app, save a copy and check that your answers have been retained.
Follow the packet's signature, witness and submission instructions. Arrange a notary visit if required; notarial service is separate from the free download.
These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.