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AUTHORIZATION TO RELEASE INFORMATION THROUGH THE ILLINOIS IMMUNIZATION REGISTRY I hereby authorize DPH (name of immunization provider or learning institution) to release information concerning immunization
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How to fill out authorization to release child
How to fill out authorization to release child:
01
Begin by filling in the top section of the form with your personal information, such as your name, address, and contact details.
02
Next, provide the details of the child for whom you are granting authorization. Include their full name, date of birth, and any other relevant identifying information.
03
Specify the authorized individuals who are allowed to pick up or release the child. Provide their full names, contact information, and their relationship to the child (e.g., parent, guardian, grandparent).
04
Indicate any specific instructions or restrictions regarding the child's release. For example, you may specify certain days or times when the child can be released, or provide details about any authorized alternate guardians.
05
Sign and date the authorization form at the bottom to validate it.
06
If required, get the form notarized, especially if you are submitting the authorization to a school or other official institution.
Who needs authorization to release child:
01
Parents or legal guardians typically need to provide authorization to release a child.
02
Authorized caregivers, such as grandparents or other family members, may also require authorization.
03
Schools, daycares, or other institutions often request authorization before allowing someone other than the child's parent or guardian to pick them up.
04
In some cases, when a child is traveling alone or with someone other than their legal guardian, a notarized authorization to release the child may be required by airlines, immigration authorities, or other travel-related organizations.
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