This authorization is intended to give Parent-Child Relationship Association (PCR) the right to give consent to not only authorization for emergency diagnostic procedures, medical, dental, surgical care and hospitalization, but for any diagnostic, medical, dental, surgical care and hospitalization that the person so designated deems advisable, and which the physician, dentist, or hospitalization personnel in said person’s judgement may deem advisable.

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It is intended that this document be presented to the physician, dentist, or appropriate hospital or medical representative at such time as the medical, dental, surgical care, or hospitalization shall be authorized. It is intended that the authorization relieve the physician, dentist, person rendering from the failure of me, the parent or guardian of the above-named minor, from signing a consent or authorization to render such care. It is the intent that PCR shall act in my stead in making such decisions