Child Care Authorization Form

Child Care Authorization Form
Parent's/Guardian's Information
Name of the Guardian
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Child Care Provider's Information
Name
First NameLast Name
Date of Beginning
MonthDayYear
Date
Date of End
MonthDayYear
Date
This Child Care Authorization form will serve as a legal and binding document that grants the child care provider the authority to:
To pick the children up from school or daycare
Authorize medical treatment or medical procedures for emergency
To provide food and housing for the children
To make decisions regarding daily activities
I give temporary authority of my child to child care provider.
Signature
Clear
Should be Empty:

Parent's/Guardian's Information