USA Authorization for Medical Treatment of Minor Child

Use this Authorization for Medical Treatment of Minor Child form to give permission to a teacher, tour coordinator, sports coach, daycare worker, or other responsible adult to:

• administer first aid to the child in the event of a minor injury,
• to procure emergency medical care if required, and
• to give his/her consent for the child to have x-rays, diagnosis or treatment if considered necessary by an attending physician.

This USA Authorization for Medical Treatment of a Minor Child form is provided in MS Word format and is easy to download, fill in and print.