Authorization by Parents
Authorization by Parents for Cryonic Preservation of a Child
The following document must be completed and signed for each living parent of the child who is to be cryonically preserved. I am the parent of and next-of-kin of _________________________________________________________________________[name of child]
who I affirm has no living spouse, and who has no living parents other than those listed here (give full name of both living parents, unless one parent is dead):     Full name of parent :____________________________________________________________________________
    Full name of parent :____________________________________________________________________________ [ALL LIVING PARENTS MUST SIGN AND HAVE NOTARIZED THE SECTION BELOW]
I have read the Cryonic Storage Agreement for Non-Member. I authorize for my child _________________________________________________________________________[name of child] to have cryonic preservation of his/her human remains. __________________________________________________________________[printed name of parent]
________________________________________________________________[printed address of parent] _____________________________________________________________________[signature of parent]
Subscribed and sworn to before me this _______ day of ____________________________________ Name of Notary Public or Lawyer _____________________________________________________
Signature of Notary or Lawyer _________________________ State or Country _________________ I have read the Cryonic Storage Agreement for Non-Member. I authorize for my child _________________________________________________________________________[name of child] to have cryonic preservation of his/her human remains.
__________________________________________________________________[printed name of parent] ________________________________________________________________[printed address of parent]
_____________________________________________________________________[signature of parent] Subscribed and sworn to before me this _______ day of ____________________________________
Name of Notary Public or Lawyer _____________________________________________________
Signature of Notary or Lawyer _________________________ State or Country _________________