Authorization for Medical Treatment of Minor Child (USA)

USA parents, you can give your consent for a responsible adult to obtain medical treatment for your child with this Authorization for Medical Treatment of Minor Child. Use this Authorization and Consent 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 is provided in MS Word format and is easy to download, fill in and print.