Parental Authorization Form For Minors

Parental Authorization Form For Minors
Mother's Name:

First NameLast Name
Parents Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Copy of the ID Card of the Parent:

Cancelof
Child's Name:

First NameLast Name
Date of Birth:

MonthDayYear
Date
I, the parent of the minor named above, do hereby & authorize * service to be provided. ( Please list the service(s) being provided.
Date of service

MonthDayYear
Date
Parents Signature
Signing this, you are authorizing the service to be provided.
Should be Empty: