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Arizona ledgment (Notary Public) _________________________________ Name typed, printed, or stamped -4- _________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking acknowprinted, or stamped State of ARIZONA ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by _________________ produced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, _______ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has________________________ State: ___________________________________ * may not be the Agent, the Agent's spouse or child, or the Notary Public -3- State of ARIZONA ) ) ss County of __________________ City: __________________________________ State: ___________________________________ Witness Signature*: ___________________________________ Name: ___________________________________ City: __________e Parents are eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness Signature*: ___________________________________ Name: __________________________________willingly, and that we, in the presence and hearing of the principal, sign this Power of Attorney for the Care of Children as witnesses to the Parents' signing and that to the best of our knowledge thildren, being first duly sworn, and do declare to the undersigned authority that the Parents sign and execute this instrument as their Power of Attorney for the Care of Children and that they sign it ____________________ Name of Mother We, ___________________________________ and ___________________________________, the witnesses, sign our names to the foregoing Power of Attorney for the Care of Chno constraint or undue influence. ________________________________ Signature of Father ________________________________ Name of Father ________________________________ Signature of Mother ____________t we sign it willingly and that we execute it as our free and voluntary act for the purposes expressed in the power of attorney and that we are eighteen years of age or older, of sound mind and under ney this _____ day of __________ and, being first duly sworn, do declare to the undersigned authority that we sign and execute this instrument as our Power of Attorney for the Care of Children and tha the Attorney-in-Fact. Dated ____________________, ______, at _________________________, Arizona. We, ____________________ and ______________________, the Parents, sign our name to this power of attorauthority of this document, without notice of such termination, shall be held harmless. -2- We may revoke this Power of Attorney before the expiration date at any time by providing written notice toy for any claims that arise against the third party because of reliance on this power of attorney. If this Power of Attorney is terminated by operation of law, any person relying in good faith on the s document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. We agree to indemnify the third partpplicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. Any third party who receives a copy of thimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If any part of this document is held to be invalid, illegal or unenforceable under an-Fact named herein. We hereby ratify and confirm all acts by the Attorney-in-Fact done by virtue of this power of attorney and the rights hereby granted. The Attorney-in-Fact shall be entitled to rei______________ ("expiration date"). By signing here, we indicate that we are fully informed as to the contents of this document and understand the full import of this grant of powers to the Attorney-ie the power to consent to the marriage of our child/children; (iii) have the power to consent to the adoption of our child/children. This power of attorney shall be in effect from _______________ to _ments. Notwithstanding other provisions in this Power of Attorney, Attorney-in-Fact shall not (i) have the authority to withhold or withdraw life sustaining procedures for any child/children; (ii) havs necessary for the performance of the powers granted by this document, including but not limited to consent forms, releases, waivers, insurance documents, claims, agreements, contracts and legal docuany health and other insurance for our child/children and to make and file any medical or other type of claim against any health or other type of insurance company. 6. Endorse and execute any documentssary on behalf of our child/children and to adjust, compromise and settle any claim, our child/children may have against any other person or entity. 5. Apply for, purchase, maintain and/or deal with ldren, including, but not limited to, provisions of living quarters, food, clothing, entertainment and other customary matters. -1- 4. Request, ask, demand, sue and take any and all legal steps nece 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/chies. 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 theical 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 procedurary 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, surgorize 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 necess 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, auth_________________ born on __________ Name: _________________________________ born on __________ The above named Attorney-in-Fact shall have the power and authority to act entirely in loco parentis and Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: ________________ 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 ________________________________________ hereby make and appoint ________________________________________ ("Attorney-in-Fact") maintaining an address at: _____________________________________________________ as______________________________________________ ("Father") and ______________________________________ ("Mother"), jointly referred to as "Parents" or "Principals", maintaining an address at: __________e appointment, the Attorney-in-Fact assumes the fiduciary and other legal responsibilities of an agent. -3- POWER OF ATTORNEY FOR THE CARE OF CHILDREN KNOW ALL PERSONS BY THESE PRESENTS: We ________ally binding upon you. If you have any questions about these powers, obtain competent legal advice. You may revoke this power of attorney at any time. ATTORNEY-IN-FACT: By accepting or acting under thower to handle and control the care, custody, health and welfare of your child/children. Any such action undertaken by the Attorney-in-Fact, within the scope of this power of attorney document, is legAttorney for the Care of Children document are broad and sweeping. Before signing this document, consider its consequences. You ("Parents") are providing another person ("Attorney-in-Fact") with the pc. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PARENTS: The powers granted by this Power of a very good idea to do so. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specifiotarization will make it more difficult for any third party to challenge the validity of the Power of Attorney. Although, some states don't require that a Power of Attorney be witnessed, it is always e, the Parents can revoke the document at any time even before the expiration date. The Power of Attorney for the Care of Children should always be notarized, even if your state does not require it. Nhould also be careful in instructing the Attorney-in-Fact as to what the Attorney-in-Fact should do. Although the Power of Attorney for the Care of Children has a beginning and an "end/expiration" datbe very careful in the selection of the Attorney-in-Fact, as the powers granted by this document are very broad and sweeping and the children are being entrusted to the Attorney-in-Fact. The Parents sng for medical, dental or any other type of care. Medical personnel will also generally feel more comfortable dealing with an Attorney-inFact who can provide this type of document. The Parents should having this type of document available, the Attorney-in-Fact will be able to better deal with any types of emergency involving the children and can avoid potential problems when, for example, arrangiseful if the parent will be absent for a period of time. The powers granted by this instrument are very broad. Parents are basically giving temporary custody of the children to the Attorney-infact. By-in-Fact by a power of attorney. This form allows the Attorney-in-Fact to make decisions for the children in place of the parents, including health care, education and welfare decisions. This can be uhe word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-in-Fact for the Parents or the children does not need to be a lawyer. Almost anyone can be appointed an Attorneybe used. This document allows parents of one or more children (sometimes called the "Principals" or "Grantors") to appoint another person to act as their Attorney-in-Fact to care for their children. Tormation Power of Attorney for the Care of Children Whenever it becomes necessary to allow someone else to provide for the care of your children, a Power of Attorney for the Care of Children form can for you and should not be used without consulting with an attorney first. [_] The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Infney-in-Fact, as the powers granted by this document are very broad and sweeping. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting pointign the Power of Attorney for the Care of Children. [_] The Parents should be careful giving instructions to the Attorney-in-Fact. The Parents should also be very careful in the selection of the Attorness should be an adult. The Attorney-in-Fact, the Attorney-inFact's spouse or children, and the Notary should not be witnesses. Although not always required, it is a good idea to have two witnesses suld keep a copy of the Power of Attorney for the Care of Children document for their records. [_] In Arizona, at least one witness needs to sign the Power of Attorney for the Care of Children. The wite Power of Attorney for the Care of Children document before a Notary. [_] The original Power of Attorney for the Care of Children document should be given to the Attorney-in-Fact. [_] The Parents sho) additional useful information about Power of Attorney for the Care of Children documents. [_] Both Parents need to sign the Power of Attorney for the Care of Children. [_] The Parents should sign thInstructions & Checklist Arizona Power of Attorney for the Care of Children [_] This package contains a (1) Power of Attorney for the Care of Children; (2) simple instructions plus a checklist; and (3 Arizona