Dorian Rothschild Maria Rothschild 60 Arthur St.

San Rafael, CA 94901 April 18, 2012 Gina Terza Tiburon Elementary School 123 Main St. Tiburon, CA 94920 Dear Gina Terza: The purpose of this letter is to advise you of the authority given to John L. Doe and Jane T. Doe while taking care of Harold D. Rothschild. This grant of temporary authority shall begin on April 25, 2012 and shall remain effective through May 03, 2012. The above Caretaker(s) shall have the authority to: - seek appropriate medical treatment or attention on behalf of the child(ren) as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits - make appropriate decisions regarding clothing, bodily nourishment, and shelter - explain absences from school - pick child(ren) up from school - sign release forms for sports - sign release forms for field trips Please contact us if you have any questions or need additional information. We can be contacted by phone at 415 567-1234 or 415 788-4565.

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Thank you for your cooperation in this matter. Sincerely,

Dorian Rothschild

Maria Rothschild

© This is a Legal Document ©

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