Temporary Child Care Authorization
Authorises a temporary caregiver (grandparent, family friend) to care for a child while the parents are away.
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TEMPORARY CHILD CARE AUTHORIZATION
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CHILD: Ellis Taylor (DOB September 4, 2018)
PARENTS / LEGAL GUARDIANS:
Jordan Alex Taylor, phone +1 503 555 0118
Riley Taylor, phone +1 503 555 0119
Address: 482 Elm Street, Apt 3B, Portland, OR 97214
CAREGIVER: Pat Anderson (Maternal grandmother)
Phone: +1 503 555 0203
Address: 21 Lakeview Drive, Portland, OR 97232
PERIOD: May 4, 2026 through May 18, 2026
(Reason: Out of town for a wedding)
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1. AUTHORIZATION
We, the undersigned parents / legal guardians of Ellis Taylor, authorise Pat Anderson to care for our Child during the period stated above. During that period, the Caregiver has temporary authority to make day-to-day decisions on our behalf, including the powers listed in Section 2.
2. POWERS GRANTED TO CAREGIVER
Routine and emergency medical care.
School drop-off, pick-up, and communication with teachers.
Extracurricular activity participation and pickup.
Emergency dental care.
Day-trip travel within the State of Oregon.
Basic discipline and routine consistent with our parenting style.
3. MEDICAL CARE — CONSENT TO TREATMENT
The Caregiver is authorised to consent to any medical, dental, surgical, hospital, or related health care for the Child that a licensed healthcare provider deems reasonably necessary, INCLUDING in any emergency. The Caregiver shall make reasonable efforts to contact us as soon as practicable; we ratify in advance any treatment decision the Caregiver makes in good faith and consistent with the Child's best interest.
Insurance: BlueCross BlueShield Oregon — policy 88312-Q
Preferred hospital: OHSU Doernbecher Children's Hospital
Pediatrician: Dr. Lin Chen, phone +1 503 555 0411
4. ALLERGIES AND MEDICATIONS
Allergies: peanuts (severe — EpiPen carried). No latex or medication allergies known.
Daily medications: none.
As-needed: albuterol inhaler for mild exercise-induced asthma.
5. EMERGENCY CONTACTS
Parent 1: Jordan Alex Taylor — +1 503 555 0118
Parent 2: Riley Taylor — +1 503 555 0119
Pediatrician: Dr. Lin Chen — +1 503 555 0411
6. LIMITATIONS
This Authorization does NOT grant legal custody, guardianship, or the right to consent to elective major surgery (except as required by emergency), to enrol the Child in school, to apply for a passport, to consent to international travel, or to make decisions outside the date range stated.
7. REVOCATION
This Authorization may be revoked at any time by either parent / legal guardian, by oral or written notice to the Caregiver. It terminates automatically at the end of the Period stated above.
8. GOVERNING LAW
This Authorization is governed by the laws of the State of Oregon.
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EXECUTION
_______________________________ Date: ____________________
Jordan Alex Taylor (Parent / Legal Guardian)
_______________________________ Date: ____________________
Riley Taylor (Parent / Legal Guardian)
NOTARY ACKNOWLEDGEMENT (recommended; required by some hospitals and schools)
State of Oregon )
) ss.
County of __________________ )
On May 4, 2026, before me personally appeared the parent(s) / legal guardian(s) named above, who acknowledged executing this instrument freely and voluntarily.
________________________________
Notary Public — signature & seal
My commission expires: ____________________
About this template
Even short-term caregivers — a grandparent for the weekend, a family friend for a week — need written authority to handle medical, school, and emergency decisions for someone else's child. Hospitals routinely refuse to treat a child for non-life-threatening conditions without a parent present unless they see a signed authorization. Schools, summer camps, and airlines often require similar paperwork. A temporary child-care authorization is NOT the same as a guardianship — it does not transfer legal custody, cannot be used to enrol the child in school in a new district, and does not survive the parents' incapacity (use a "standby" or "kinship" guardianship designation for that). It is a limited, time-bound delegation of authority that hospitals and similar institutions can rely on. Notarisation is highly recommended even where not strictly required: a notary stamp moves the document from "this looks plausible" to "this is presumptively authentic." Some states (California, Florida, others) have a specific statutory form called a "Caregiver's Authorization Affidavit" — using the statutory form gets the strongest possible legal effect, especially for caregivers acting longer than a few weeks.
When to use it
- Parents travelling without the child for a weekend, week, or longer.
- A child staying with a grandparent or relative for the summer.
- A close friend or relative driving the child to or from camp.
- A grandparent attending a school event without the parents present.
- Any time a medical or school decision might need to be made while the parents are unreachable.
What to include
- Identification of child, parents, and caregiver.
- Date range of the authorization.
- Specific powers granted (medical, school, travel).
- Insurance, pediatrician, and emergency contacts.
- Allergies and current medications.
- Notarisation (highly recommended).