Another example for you, it's what we use........
My sister also puts an actual insurance card in the envelope with this, along with their contact info.....We've never had to seek medical help, but are ready. The whole shebang is taped on the inside of the medicine cabinet mirror in the bathroom, so if something happens, we can grab it and run.
Change the state and county to where you live, obviously, and fill in your names.
AUTHORIZATION TO CONSENT FOR EMERGENCY MEDICAL TREATMENT
The undersigned, the parents of _______________, do hereby grant to ______________ and/or ______________, full and complete authority to consent to any and all medical treatment which, in his/her sole judgment, is necessary under the circumstances.
Dated: _________________ (signed)_____(mom)____________
Dated: _________________ (signed) _____(dad)_______________
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF WESTMORELAND
On this ____day of February, 2009 before me, a notary public in and for said state and county, personally appeared _____(mom)__________ who acknowledged herself to be the person named in the foregoing instrument and that she executed the same as her act and deed.
Witness my hand and notarial seal the day and year first above written.
____________________ My Commission Expires:
Notary Public
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF WESTMORELAND
On this ____day of February, 2009 before me, a notary public in and for said state and county, personally appeared _____(dad)__________ who acknowledged herself to be the person named in the foregoing instrument and that she executed the same as her act and deed.
Witness my hand and notarial seal the day and year first above written.
____________________ My Commission Expires:
Notary Public