Do your due diligence on researching local laws and regulations as well policies for children traveling alone with various transportation agencies, e.g. airlines, trains, etc.

Editable form courtesy of http://www.contemporaryparent.com/

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MEDICAL AUTHORIZATION FORM

In case of a medical emergency during our absence, please try to reach us, the parents, at the following numbers

(name) (relationship) (phone number)

Mary Smith Mother 808-888-XXXX

John Smith Father 516-223-XXXX

Additionally, we, the undersigned and parents of (name of child) and (name of second child, if applicable), hereby authorize the following persons

(name) (relationship) (phone number)

(name) (relationship) (phone number)

(name) (relationship) (phone number)

(name) (relationship) (phone number)

and

(name) (relationship) (phone number)

to authorize any and all medical treatment for (name of child(ren) that he/she deems appropriate., This includes, but is not limited to, treatment to relieve pain or discomfort. Please note: (name of child) is allergic to ibuprofen and therefore can only be given acetaminophen or similar.

A photocopy of this authorization shall be deemed effective as if it were an original. This authorization shall remain in effect until (date children will be back in your care or other date of your choosing).

Known allergies:

(name of child) Ibuprofen

Both children are allergic to dust and cat hair

MEDICAL INSURANCE COMPANY                                        ________________________
MEDICAL INSURANCE ID OR GROUP #                                ________________________
IDENTIFICATION NUMBER OF INSURED (name of child)                ________________________

IDENTIFICATION NUMBER OF INSURED (name of child)                ________________________