KNOW ALL PERSONS BY THESE PRESENTS:
We ______________________________________________________ ("Father")
and ______________________________________ ("Mother"), jointly
referred to as "Parents" or "Principals", maintaining an address
at: ________________________________________ hereby make and
appoint ___________________________________ ("Attorney-in-Fact")
maintaining an address at: _____________________________________
as our true and lawful agent and attorney-in-fact for us and in
our name, and in
our behalf to act as the guardian of our minor child/children:
Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
The above named Attorney-in-Fact shall have the power and
authority to act entirely in loco parentis and to do all acts
necessary or desirable for maintaining the health, education,
and welfare of our above named child/children, including, but
not limited to, the powers to:
1. Provide for, approve, authorize and decline any health care
at any hospital or other institution; employ any physicians,
dentists, nurses, or other person whose services may be needed
for such health care; review and if necessary disclose the contents
of any medical records; execute any consent, release
or waiver of liability required by medical, dental or other health
authorities incident to the provision of medical, surgical or
dental care to our child/children. Health care shall include but
not be limited to the administration of anesthesia, X-ray
examination, performance of operations,diagnostic and other
procedures.
2. Determine the education of our child/children and to register
and enroll our child/children in any educational programs, schools
and extracurricular activities; review any school records of the
child/children; allow our child/children to participate in
activities and events offered by any group, organization or
educational facility.
3. Maintain the customary living standard of the child/children,
including,but not limited to, provisions of living quarters,
food, clothing,entertainment and other customary matters.
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