Form Authorizing Information Release
The text below can be pasted into a document, printed, and taken to a Notary Public to witness your signing it in their presence.
For your convenience, you can also download our printable PDF of the authorization form.
AUTHORIZATION FOR RELEASE OF INFORMATION
I, ____________________________________, hereby authorize ______________________________ to release information to or discuss my child ____________________________, whose date for birth is _______________________,
Parent/Guardian Signature ________________________________________________
Date Signed ___________________________________________________________
Notary Signature _______________________________________________________
County/Parish of ________________________ State of ________________________
My Commission Expires _________________________________________________