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The following document must be completed and signed for each living child of the parent who is to be cryonically preserved.
We are the children of _________________________________________________________[name of parent]
who we affirm has no living spouse, and who has no living children other than those listed here (give full name of ALL living children):
[EACH CHILD MUST SIGN AND HAVE NOTARIZED THE SECTION BELOW]
I have read the Cryonic Storage Agreement for Non-Member.
I authorize for my parent___________________________________________________[name of parent]
to have cryonic preservation of his/her human remains.
__________________________________________________________________[printed name of child]
________________________________________________________________[printed address of child]
_____________________________________________________________________[signature of child]
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 parent___________________________________________________[name of parent]
to have cryonic preservation of his/her human remains.
__________________________________________________________________[printed name of child]
________________________________________________________________[printed address of child]
_____________________________________________________________________[signature of child]
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 parent___________________________________________________[name of parent]
to have cryonic preservation of his/her human remains.
__________________________________________________________________[printed name of child]
________________________________________________________________[printed address of child]
_____________________________________________________________________[signature of child]
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 parent___________________________________________________[name of parent]
to have cryonic preservation of his/her human remains.
__________________________________________________________________[printed name of child]
________________________________________________________________[printed address of child]
_____________________________________________________________________[signature of child]
Subscribed and sworn to before me this _______ day of ____________________________________
Name of Notary Public or Lawyer _____________________________________________________
Signature of Notary or Lawyer _________________________ State or Country _________________