A grandparents' medical consent form allows a parent or legal guardian to hand over all responsibility regarding their child's healthcare decisions. Responsible Party: Name, Address, Home Phone Number.Birth Date, E-Mail Address. This policy outlines consent for medical treatment and identification of a surrogate decision- maker to consent to treatment. How to fill out the Grandparent Medical Consent Form for Minors? Download a free Medical Consent Form for Babysitter. Below is a listing of forms that may be required for participants in Harris County's recovery programs.