CHILD CARE AUTHORIZATION
(This is a suggested format and must be filled out in entirety)
 
I (print parent's name)________________________________, the undersigned parent of (child's name)___________________________, hereby grant
(print guardian's name)___________________________, temporary guardianship for the child named above.     
This grant of temporary guardianship shall begin on (date)__________
and remain in effect until (date)_________.                                                                        
The above named guardian shall have the power to: (Initial ALL that apply)
 ___  Seek appropriate medical treatment or attention on behalf of the child as may be required by the circumstances, including, but not limited to, medical doctor and/or hospital visits.
 
___ Authorize medical treatment or medical procedures in an
emergency situation.
 
___ Sign release forms for sports, field trips or related activities.
 
___ Specifically to sign any releases to authorize participation in any
Special Program activities at Theater of the Sea, not limited to the
Dolphin Swim.
 
___ Are granted guardianship for all of the above purposes and
associated activities that may pertain thereto without limitation.

Scheduled date of program(s) _________________________________

Please note that (print child's name) ____________________________
has a specific medical condition or allergy as described: ___________
__________________________________________________________
__________________________________________________________
 
(Parent’s Signature) __________________________________________

(Date) __________________

(Notary) ______________________________________________

This form must be notarized or fax enlarged copy of drivers license
as proof of signature. FAX number 305-664-8162.
                                                                               
(1-06)

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