POWER OF ATTORNEY FROM PARENT OR GUARDIAN



DURABLE POWER OF ATTORNEY FROM PARENT OR GUARDIANDELEGATION OF POWERS BY PARENT OR GUARDIAN.A parent or a guardian of a minor or incapacitated person, by a properly executed power of attorney, may delegate to another person, for a period not exceeding one year, any powers regarding care, custody, or property of the minor child or ward, except the power to consent to marriage or adoption of a minor ward. It is the joint intention of _______________ and ___________________, the parents of the minor children named below, to provide for the safety and security of their minor children in the event of the disability or death of the custodial parent, _______________________. ________ and ________, at the time of execution of this Delegation, live or intend in the near future to live on different continents. Therefore, to avoid the children being placed in foster care in the event of an accident or death of the custodial parent, they delegate the persons named below to care for their children until such time as ________ can make travel arrangements to pick up the children and to transport them to his home. It is the mutual intent of both ________ and ________ to make this Durable Power of Attorney effective until such time as it is revoked with the same formality as this execution or until such time as ________ is able to assume custody of the children in the event of ________’s demise.Our full legal names are _____________________________________________________and ____________________________________Our identifying information is:Mother (_______________________________):Date of birth: ________________________________Current address: _____________________________ _____________________________Phone: _____________________________________:Father: _____________________________________Date of birth: ________________________________Current address: _____________________________ _____________________________Phone: _____________________________________We are the parents and legal guardians of __________________________________________, a minor child, whose identifying information is:Social Security Number: _XXX-XX________ (last 4 digits)Date of Birth: _________________________________ANDWe are the parents and legal guardians of _____________________________________, a minor child, whose identifying information is:Social Security Number: _XXX-XX________ (last 4 digits)Date of Birth: _________________________________We hereby delegate to:__________________________________________________________________________________________Address: __________________________________________________Telephone Number: _________________________________________and to each of them as our attorney-in-fact only those parental powers enumerated below:To provide room, board and social activities to our children;To execute authorizations in favor of teachers, counselors and other school personnel as necessary to enable my attorneys-in-fact to discuss otherwise confidential information regarding our children’s physical and mental health, academic performance and behavioral issues with teachers, social workers, counselors, other school personnel; To execute school parental permission forms for course selection, in-school activities and extracurricular activities including sports;To speak to law enforcement agencies, courts and probation departments in the event our children are involved in a matter within their respective jurisdictions;To give consent to medical treatment, whether or not emergent, for our children’s physical and mental health conditions;To exchange otherwise privileged or protected information with physical and mental health care providers treating our children;To execute applications to and exchange confidential information with the Department of Human Services and other public and private entities as necessary to obtain or retain financial and other benefits and services for our children; andTo transport or arrange to transport or give consent to transport our children by private or public conveyance as necessary to carry out any delegated power herein.The delegation of powers under this Power of Attorney shall not be affected by our disability, incompetency, or incapacity, but unless otherwise revoked with the same formality as executed here, shall not be affected by a parent’s death until the children are delivered into the hands of the surviving parent. If one of us is deployed as a serviceperson in the United States military, and that parent’s deployment period exceeds one year, it is our mutual intent that this Power of Attorney shall continue in effect until at least one month after the deployed parent’s return from active duty deployment, unless we revoke it as provided above.A copy of this Power of Attorney shall be as valid as the original.WE UNDERSTAND THAT BY EXECUTING THIS DELEGATION OF PARENTAL AUTHORITY WE ARE NOT RELIEVED EVEN TEMPORARILY OF ANY FINANCIAL OR OTHER OBLIGATIONS RESPECTING OUR CHILDREN FOR WHICH WE ARE LEGALLY RESPONSIBLE.Signature of Parent with Legal Custody ________ DATE:WITNESSED BY:________________________Subscribed and sworn to before me on:(print name)_____________________, ________(date)________________________(print name)______________________________ Notary Public__________________ County, __________My Commission expires: ___________Signature of Parent with Legal Custody ________ DATE:WITNESSED BY:________________________Subscribed and sworn to before me on:(print name)_____________________, ________(date)________________________(print name)______________________________ Notary Public__________________ County, __________My Commission expires: ___________ ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download