Free Medical Consent Letter for Babysitter (Sample)

A child’s medical consent letter is a legal document that gives someone other than the child’s parent or legal guardian temporary permission to seek and deliver healthcare and make healthcare choices on their behalf. 

Learn how to prepare a letter of medical consent for a babysitter. As a template for your medical consent letter, use our sample medical consent letter for babysitter.

Sample Medical Treatment Consent Letter For Babysitter

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


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.

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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

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