POWER OF ATTORNEY FOR MINOR CHILD

_____________________________________, As the mother/father/legal

custodian of the minor child, __________________________________,

(DOB _____/_____/________), here by grants to __________________,

(Relationship to child ______________________), Power Of Attorney

to act in my stead in the interest and in the benefit of _________________.

This Power Of Attorney, includes, but, is not limited to obtaining medical

Information and authorizing routine and emergency medical care,

Enrollment and participation in educational, recreational, and

Employment progrmas, providing for transportation and housing needs,

And applying for benefits or services to which the child may be entitled.

I, __________________________________, further declare that I grant

This Power Of Attorney knowingly and voluntarily after having comsulted

With an attorney concerning both myself and my child. This Power Of

Attorney will remain in effect for six months from the date of signature,

Pursuant to Arizona statue.

I, __________________________________, further declare that

_________________________________, has my consent to file for legal
guardianship of _________________________________, and that this

shall serve as my written consent to such guardianship proceedings.

Dated this _________ day of ________________________, 20________

_________________________________
Signature of Parent/Guardian

____________________________________________
Address
____________________________________________

Telephone Number:___________________________

SUBSCRIBED AND SWORN THIS _________ DAY OF

____________________________, 20______________

BY: _________________________________