ASamplePowerofAttorneyForm

I/wearetheparent(s)of______________________________,
born_______________,aminorchild.I/wegive
to:________________________thefullauthoritytoactinmy/our
placeregardinganymatterconcerningthecare,custody,orproperty
ofthischild,including,butnotlimitedto:grantingofconsentfor
anymedical,dental,psychological,psychiatricexaminations,care,
ortreatmentincludingvaccinationsorimmunizations;enrollmentin
schoolandparticipationinschoolactivities;applyingforpublic
benefits;andanyothermatterregardingthehealthorwelfareofthis
child
except:_________________________________________________
_____.
Thispowerofattorneyshallbevalidforaperiodendingbutinno
caseformorethreeyears.
I/wereservetherighttoterminate(end)thisauthorityatanytime.
Signed:_________________________________________________
_
SIGNEDANDSWORNTObeforemeonthis______dayof
________,
20___,by_______________________________________________
_.
Signatureof
Notary:_______________________________________