1. Authorized Healthcare Providers: Optional section to specify particular healthcare providers or facilities authorized to provide treatment

2. Insurance Information: Details of medical insurance coverage, if applicable

3. Religious or Cultural Considerations: Any religious or cultural preferences that should be considered in medical treatment

4. Prohibited Treatments: Specific treatments or procedures that are explicitly not authorized

5. Travel Authorization: Additional authorization for medical treatment during travel, if the form will be used for travel purposes

6. Temporary Caregiver Authorization: Authorization for temporary caregivers to make medical decisions when parents are unavailable

1. Schedule A - Medical History Form: Detailed medical history form including vaccinations, previous illnesses, surgeries, and family medical history

2. Schedule B - List of Current Medications: Comprehensive list of current medications, dosages, and administration schedules

3. Schedule C - Emergency Protocol: Specific instructions for emergency situations, including preferred hospital and known medical risks

4. Appendix 1 - Identification Documents: Copies of relevant identification documents for both child and parents/guardians

5. Appendix 2 - Insurance Cards: Copies of insurance cards and relevant policy information