| This authorization form can allow a child 
                to be treated without the parent or guardian present. Lets face 
                it, we cannot be right beside our children 24/7/365. Having one 
                of these forms filled out can, in most cases, ensure that your 
                child can receive the treatment they need at a hospital or anywhere 
                else a babysitter, grandparent, coach, etc. takes him or her. Simply fill this form out (for your convenience you can insert 
                most of the information right on your computer), sign it in front 
                of a Notary Public, and give a copy to whoever will be watching 
                your child. It is probably a good idea to give that same person a Treatment 
                Protocol Letter to accompany the authorization form. This way 
                they have one document telling them how to treat your child and 
                a second one authorizing them to treat. |