To whom it may concern,

As a parent and/or guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor of the following person in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed.
In case of a minor, this authority is granted only after a reasonable effort has been made to reach the parent and/or guardian.