Power of Attorney – Care of Children One Parent

KNOW ALL PERSONS BY THESE PRESENTS:

I, ___________________________________________________ (“Parent”), maintaining an address at: ________________________________________. I am an adult and I am the custodial parent having full legal custody of:

Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
Name: _________________________________ born on __________
I hereby make and appoint ________________________________________ (“Attorney-in-Fact”) maintaining an address at: _____________________________________________________ as, my true and lawful agent and attorney-in-fact for me and in my name, and in my behalf to act as the guardian of my above-named minor child/children:

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 my 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 the 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 the child/children and to register and enroll the child/children in any educational programs, schools and extracurricular activities; review any school records of the child/children; allow the 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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