JUSTIN HOLLOWAY
XYZ Company.
1234 Archer Road
Gainesville, Fl 32607
[Subject: Normally bold, summarizes the intention of the letter] -Optional-
Dear Justin holloway,
I authorize Rainbow Daycare Center to approve of any doctor recommended medical treatment urgently needed by my daughter in cases when I am unavailable or difficult to contact. The authorization is in force from 2011 March 20 to 2011 March 31 and applies only to emergency situations.
NOTE: This form MUST be signed and dated by the person/s giving authority.
Sincerely,
James hall