Kenneth Vercammen is a Middlesex County Trial Attorney who has published 130 articles in national and New Jersey publications on Criminal Law, Probate, Estate and litigation topics.

He was awarded the NJ State State Bar Municipal Court Practitioner of the Year.

He lectures and handles criminal cases, Municipal Court, DWI, traffic and other litigation matters.

To schedule a confidential consultation, call us or New clients email us evenings and weekends via contact box www.njlaws.com.

Kenneth Vercammen & Associates, P.C,

2053 Woodbridge Avenue,

Edison, NJ 08817,

(732) 572-0500

Monday, October 17, 2011

Parental Consent to Authorize Medical Treatment of Minors

Parental Consent to Authorize Medical Treatment of Minors

I/We, ________________________________________________, am/are the parent(s) of _____________________________________________, born [date of birth for each minor child]_______________________________________. I am/We are placing my/our child(ren) into the care of ____________________________________ during our absence. I/We authorize __________________________________ to consent to any medically necessary X-ray, examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care recommended for the benefit of my/our child(ren). Such medical care is to be rendered to said child under the care, supervision, and advice of a physician or other medical care provider licensed to practice medicine in any state in the United States. I/We further authorize ________________, to consent to any X-ray, examination, dental or surgical diagnosis or treatment, and hospital care to be rendered to my/our minor child(ren) by a dentist licensed to practice dentistry in any state in the United States.
This authority shall be valid from ________________ to ______________, 20__.
Executed this ______ day of ____________________, 20__ at ______________, ________.
__________________________________________
Parent’s Signature

__________________________________________
Parent’s Signature

State of _________________________
County of _______________________

On ________________, 20__, _________________________________________

________________, personally appeared before me and executed this document. WITNESS my hand and official seal.

__________________________________________
Notary Public