All free templates · Releases, waivers and consents

Medical consent for a minor

Letting a grandparent, sitter, coach or school get medical care for your child while you are away.

Use this templateOpens in Sealquill with the signature lines placed. Free plan, no card.

What you fill in

Child’s full name
Date of birth
Date
Caregiver’s name
List
Name and phone

Blanks are shown in [square brackets]. Edit the text in Sealquill before you send it; the PDF editor changes the real words.

Medical Consent for a Minor

This authorization is given by the parent or legal guardian named below.

1. The child

I am the parent or legal guardian of [child’s full name], born [date of birth].

2. Authorization

From [date] to [date], I authorize [caregiver’s name] to consent to medical and dental examination and treatment for my child that a licensed professional advises, when I cannot be reached in time.

3. Health details

Allergies and medications: [list]. Doctor: [name and phone]. Insurance: [insurer and member name]. My contact numbers: [numbers]. Some hospitals have their own forms: ask yours.

Parent or guardian

Signature, name and date

More releases, waivers and consents templates

This template is a general starting point and is not legal advice. Laws differ from place to place and every situation is different: have a lawyer review anything important before you rely on it.

Send it for signature in a few minutes.

Use this templateSigners need no account and can sign on a phone.