This form grants authority to a designated adult(s) to provide and arrange for medical care for my/our child when I/we are not present or when it is not practical or feasible to contact me/us. The designated adult may make medical decisions and/or approve emergency care. The designated adult may attend appointments and schedule follow-up care. As the parent or legal guardian, I/we assume financial responsibility, whereas the designated adult has no financial responsibility for my/our child’s medical care.