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1. Child's Information: Full legal name, date of birth, address, and any identifying information of the child
2. Parent/Guardian Information: Complete contact details of parents/legal guardians, including alternative contact numbers
3. Babysitter Information: Full name and contact information of the authorized babysitter
4. Medical Authorization: Explicit authorization for the babysitter to consent to medical treatment in parents' absence
5. Medical History: Child's relevant medical history, including allergies, current medications, and chronic conditions
6. Emergency Contacts: List of additional emergency contacts in order of priority
7. Primary Healthcare Provider: Contact information for child's regular doctor and preferred hospital
8. Insurance Information: Health insurance details including policy number and provider contact information
9. Effective Period: Validity period of the consent form
10. Signature Block: Space for dated signatures of parents/guardians and witness
1. Religious Preferences: Specific religious considerations regarding medical treatment, used when parents have religious-based medical restrictions
2. Specific Procedures Excluded: List of any medical procedures specifically not authorized, used when parents want to restrict certain treatments
3. Transportation Authorization: Permission for babysitter to transport child for medical care, included when babysitter may need to drive child
4. Cost Authorization: Maximum authorized spending limit for medical care, used when parents want to set financial boundaries
5. International Travel Consent: Additional authorization for medical treatment abroad, included if family lives near international borders or travels frequently
6. Indemnification Clause: Protection for babysitter against liability when acting in good faith, used in high-risk situations or at babysitter's request
1. Schedule A - Vaccination Record: Detailed list of child's vaccinations and dates
2. Schedule B - Medication Schedule: Current medication details including dosage and timing, if applicable
3. Schedule C - Emergency Action Plans: Specific steps for known medical conditions (e.g., asthma, allergies)
4. Appendix 1 - Copy of Health Insurance Card: Photocopy or scan of current health insurance card
5. Appendix 2 - Medical History Documents: Copies of relevant medical records or doctor's notes
6. Appendix 3 - Emergency Contact Card: Wallet-sized card with key emergency information and contacts
Healthcare
Childcare Services
Education
Social Services
Insurance
Legal Services
Domestic Services
Legal Affairs
Child Protection
Healthcare Administration
Emergency Services
Insurance Processing
Social Services
Document Management
Compliance
Risk Management
Babysitter
Nanny
Childcare Provider
Healthcare Administrator
Pediatrician
Emergency Room Physician
Family Lawyer
Insurance Claims Processor
Child Protection Officer
Social Worker
School Administrator
Daycare Center Manager
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