SAMPLE
Names of Parties:
The parent(s) or guardian(s) granting this authority is __________,
The person who is the authorized caregiver is __________,
The caregiver is authorized to provide the specified care for the following child: __________,
Powers Granted by this Authorization
is granted the following powers over the above-named child or children: __________,
Miscellaneous
This authorization will become effective on __________,
and will remain in effect until terminated by the undersigned
parents or guardians.
This authorization is signed in the County of , State of Florida |
