certify that I am the parent or legal guardian of the minor listed below, and as such, I hereby convey temporary authority to the below designated adults for the sole purpose of obtaining or arranging any emergency medical or dental care for the minor as may be deemed necessary for the well-being of the minor when not accompanied by a parent/legal guardian or should either parent/legal guardian be unreachable by telephone.
THEREFORE, I hereby approve and empower the below listed individuals with the authority to arrange and/or consent for any and all emergency medical/dental care and treatment of the minor in my absence.