[Your letterhead, if desired; if not, your return address]

[Date of letter-month, day, and year]

[Recipient's first and last names]
[Company name]
[Street or P.O. box address]
[City, State ZIP code]

Dear [recipient's name]:

I hereby authorize Greenway Child Care to provide emergency care, should it be needed, for my two children during their enrollment at the facility. Their names are Sam (age 4) and Scott (age 2).

If emergency care is ever needed and administered, please contact me immediately at the phone number that you have on record, which is 920-555-1213.

Sincerely,

[Signature]

[Sender's first and last names]