MAKE YOUR FREE Elder Care Authorization Form
Other Names:
Authorization for Eldercare
Elder Care Authorization
Authorization of Care
Elder Care Directive
Guardian Authorization Form
Caregiver Authorization Form
What is an Elder Care Authorization Form?
An Elder Care Authorization Form is a document that grants a caretaker temporary custody of an older adult who needs elder care.
When to use an Elder Care Authorization Form:
- You want to designate someone to take care of an elderly adult person.
- You want to provide specific authority and powers to the caretaker.
- You want to provide emergency contact information.
Sample Elder Care Authorization Form
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Elder Care Authorization
I, the undersigned , hereby grant:
(the "Caretaker),
,
the authority to take temporary care of the following adult: . I grant this authority in my capacity as 's . My contact information is as follows:
,
This grant of temporary authorization to provide elder care shall begin on , and shall remain effective until terminated by the undersigned.
The Caretaker shall have the power to:
| Other instructions: |
In an emergency situation, please contact the following person:
| Name: |
| Address: |
,
| Phone Number: |
If that person is not available, please contact the following alternate choice:
| Name: |
| Address: |
,
| Phone Number: |
| By: | Date: |
