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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 _________________


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