Recommended medical treatment urgently

August 23, 2011


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.

James hall

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