Medical Consent Form Grandparents

June 20, 2011

A medical consent form grandparents authorizes the grand parents of particular children to take care of those children medical responsibilities in the event that the parents are not in a capacity to do so. It ensures that the children will be well taken care of incase of emergencies. A sample medical consent form grandparents is given below.
Sample Medical Consent Form Grandparents

We Mr. _____________________ and Mrs. ________________________ do authorize our parents Mr. ____________________ and Mrs. ______________________ of telephone _______________________ to have legal authority and take care of our children incase of any medical emergency or incidence.

Child 1 name: _________________________

Blood type: ___________________________

D.O.B: _______________________________

Insurance: _______________       certificate __________

Group: _______________________________

Child 2 name: __________________________

Blood type: ____________________________

D.O.B: ________________________________

Insurance: _______________    certificate _____________

Group: _________________________________

Child 3 name: ____________________________

Blood type: ____________________________

D.O.B: ______________________

Insurance: ____________________   certificate _____________

Group: ______________________

Mr. ________________________

Telephone:  ________________   sign: _____________

Mrs. _____________________

Telephone: ____________         sign: ___________

Date: _________________

 

Download Medical Consent Form Grandparents in Word Format

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