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       Facebook Temporary authorization for the care of a minor person LINKED IN Temporary authorization for the care of a minor person del-icio-us Temporary authorization for the care of a minor person

Temporary authorization for the care of a minor person

To Whom This May Concern

This letter is in regards to the following child:

Brian Miller
10 Free Street
Hometown OH, 00000
Date of Birth: March 8, 2009

I affirm that the above-named minor child is under my legal custody and care and is my child by right.

I hereby grant full authorization and consent for the above-named child to live under the temporary care and custody of the person(s) named below:


Guardian Name (If more than one list each on separate lines)
Morgan Freed
Juliet Freed

Guardian Address:
52 West Road
Hometown OH, 00000

I hereby grant the temporary guardian permission for the following:

  1. To authorize any medical and dental care as recommended by a qualified and licensed physician, dentist, or medical professional
  2. To act in all matters relating to the educational and recreational activities of the above-named child
  3. To pay for such living expenses, medical and dental expenses which are deemed necessary and to sign on my behalf any insurance forms necessary for services provided while the child is in their care.

This temporary authorization shall be effective for the time between March 8, 2009 to March 15, 2009.

Parental Signature:
Printed Name:
Date:
         


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