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More information on a Parental Authorization relating to a
minor child This authorization may only be used between a parent of a minor child and a person who is the minor child’s grandparent, adult sibling, or adult aunt or uncle. This agreement may be used for only ONE minor child. If you have other minor children for whom you desire similar authorizations, you must use a separately prepared and signed agreement relating to that child. You can authorize your relative to have the following powers (or any subset of them): • Authorize medical, dental, psychological, or surgical treatment and immunization of the child to whom this authorization applies, including executing any consents or authorizations for the release of information as required by law relating to the treatment or immunization; • Obtain and maintain health insurance coverage for the child to whom this authorization applies and automobile insurance coverage for the child to whom this authorization applies, if appropriate; • Enroll the child to whom this authorization applies in a day-care program or preschool or in a public or private primary or secondary school; • Authorize the child to whom this authorization applies to participate in age-appropriate extracurricular, civic, social, or recreational activities, including athletic activities; • Authorize the child to whom this authorization applies to obtain a learner’s permit, driver’s license, or state-issued identification card; • Authorize employment of the child to whom this authorization applies; • Apply for and receive public benefits on behalf of the child to whom this authorization applies. There cannot be any other parent, guardian, custodian, licensed child-placing agency, or other authorized agency that asserts any claim or authority inconsistent with the authorization agreement with regard to actual physical possession or care, custody, or control the minor child. If there IS a court proceeding already in place, the court must approve the Authorization Agreement before it is effective. If there is a court proceeding underway, DO NOT request this document from the Virtual Online Law Office unless you are prepared to seek that court authorization on your own. If there is NO court proceeding already in place, you must certify in the Authorization Agreement that: 1.1. There is no court order or pending suit affecting the parent-child relationship; and1.2. There is no pending litigation in any court concerning:
1.2.1.
custody,
possession, or placement of
the child;
or
1.2.2.
access to
or visitation with the child; and
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