Permission Slip

Permission Slip

Jurisdiction: 

Area of Law: 

This is an example of a permission slip conferring consent to a person to act as guardian of another person's children for a specified amount of time. This document is provided as is without any warranty and is not intended to be used as a substitute for legal advice. 

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PERMISSION SLIP

 

The Affiant, being duly sworn, hereby declares as follows:

 

 

 

I am the mother/father of _______________________ (“My Child”).

 

I give permission to ___________________ (“Guardian”) to act as guardian of My Child from __ until __ (the “Term”).

 

During the Term, the Guardian may make all medically necessary medical decisions at the advice of competent medical professionals in regard to My Child.

 

During the Term, the Guardian may interact with My Child’s school or any other party as may be necessary in the reasonable discretion of the Guardian.

 

 

 

Other instructions:

 

 

 

 

 

 

 

 

NOTARY:

 

STATE OF VERMONT

COUNTY OF ________________)

 

On this  __ day of   ______, 20__, before me personally appeared ________________, and known or proved by identification to me to be the person described in and who executed the foregoing instrument and having sworn to the above stated facts, acknowledged that he/she executed the same (in his/her authorized capacity) as his/her free act and deed.

 

__________________________

Notary Public

My Commission Expires on:

 

 

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