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Authorization by Children

Authorization by Children for Cryonic Preservation of a Parent

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):

    Full name of child :____________________________________________________________________________

    Full name of child :____________________________________________________________________________

    Full name of child :____________________________________________________________________________

    Full name of child :____________________________________________________________________________

    Full name of child :____________________________________________________________________________

    Full name of child :____________________________________________________________________________

[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 _________________


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