Free Medical Consent Letter for Babysitter (Sample)

Name of Parent
Address of Parent
City, State, Zip Code

DATE

Name of Babysitter
Address of Babysitter
City, State, Zip Code

RE: Consent for Medical Treatment of Name of Child

To Whom It May Concern:

The purpose of this letter is to authorize [Name of Babysitter] to take my four-year-old son [Name of Son] to [Name of Doctor, Address of Doctor, and Phone Number] or [Name of Hospital, Address of Hospital, and Phone Number] if a medical emergency arises or medical attention is required while I am unavailable.

If [Name of Son] gets a fever before seeing a doctor or going to the hospital, [Name of Babysitter] is also allowed to give him OTC children’s Tylenol. Name of Son has no known pharmaceutical intolerances or allergies.

[Name of Babysitter] has authorization to provide insurance information if requested by the hospital or doctor. When [Name of Babysitter] leaves my employment, this authorization expires.

Sincerely,

Parent’s Signature
Parent’s Name Printed And Relation To The Child I.E. Mother, Father Of Child date of signing

Copies To: Name Of Hospital, Name Of Doctor, Name Of Babysitter, Name Of Insurance Agent Or Company