Child Care Authorization



To:  Whom it May Concern


The purpose of this letter is to advise you of the authority given to _________________ (“Child Care Provider”) over _______________________________________ (“Minor Children”).


This grant of temporary authority shall begin on _____________ and end on __________, unless terminated earlier by any of the undersigned.


The above Child Care Provider shall have the absolute and final authority to:


1. Seek appropriate medical treatment or attention on behalf of the Minor Children as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits.

2.  Authorize medical treatment or medical procedures in an emergency situation.

3. Make appropriate and necessary decisions regarding clothing, bodily nourishment, and shelter.

4.  Explain absences from school; pick Minor Children from school.

5.  Sign release forms for sports and field trips.


Thank you for your understanding, cooperation and prompt adherence to this authorization.



Yours very truly,



________________                _________________                          _________________

Parent 1                                  Parent 2                                              Child Care Provider




Names of Children;

Social Security Numbers, if available



Child Care Authorization

Review List


This review list is provided to inform you about this document in question and assist you in its preparation.  Child Care Authorization is an underused document that can be very useful to get prompt medical or other attention to your children in an emergency.  We strongly recommend that you keep health cards and related information with this Authorization so the Child Care Provider is totally prepared in case of an emergency, which is not time to be hunting up medical permissions or documents.


You should keep this document on the front hall table for easy access by the Provider.  You can always suggest they keep a second copy in their car or yours, if they use it.


You should always execute this document if leaving home on an overnight, but especially if you are leaving home for any extended period of time and have another person caring for your children.


1.  Sign multiple copies.  Give one or more to the Provider and keep them as suggested above.


2.  This well care document can be very useful.  As a practical matter, print out several after filling in the blanks and have them readily available so you use them when gone on trips.




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