When your child is in an activity with a school or other organization, you will usually be asked
to sign an authorization. Less formal groups may not have a form, and the form used by your
group may not cover all of the conditions you wish to impose upon the activity. For these
instances, a CHILD AUTHORIZATION form can be used.
Sample Child Authorisation
To: _____________________________________________
This is to confirm that my child, __________________________________________, is authorized to participate in:
___________________________________________________________ on _______________________, 20_____
under the following conditions:
If these conditions will not be met, my child may not participate.
During participation, I can be reached at:
Cell phone:____________________________________________________
Beeper: _______________________________________________________
Other phone:__________________________________________________
Other phone:__________________________________________________
If I cannot be reached in any of these ways, I authorize _________________________________________ to consent
to any emergency medical care that may be necessary.
_____________________________________
Parent
Accepted by:
_____________________________________
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