This form should be filled out and notarized if either parent/guardian is out of town and are leaving someone in charge of your child, or if your child is going on a field trip out of the state or country.  Teachers and chaperones may make copies of this form to pass out to your students or include in your field trip informational packets.

If your child becomes  ill or injured and needs emergency treatment, it will be necessary for you, as parent or legal guardian, to give consent for treatment.

The purpose of the attached form is to give another person or agency the authority to grant such permission (consent) in your absence.  This will allow the physician or emergency care facility to begin treatment for your child without delay.