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Louisiana ______________________________________________ Notary Public -3- RN TO AND SUBSCRIBED before me, Notary Public in and for the parish / county and state aforesaid, this __________ day of ________________________________________________ , __________. ____________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ STATE OF LOUISIANA, COUNTY / PARISH OF _________________________: SWO_______________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: _______________________________en notice to the Attorney-in-Fact. Signed on ________________ (date), at _______________________ (city), Louisiana. ________________________________ Signature of Parent Witness Signature: ____________faith on the authority of this document, without notice of such termination, shall be held harmless. -2- I may revoke this Power of Attorney before the expiration date at any time by providing writthe third party 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 a copy of this 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. I agree to indemnify tceable under applicable 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 receivesntitled to reimbursement 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 unenfor the Attorney-in-Fact named herein. I 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 e_____________ to _______________ ("expiration date"). By signing here, I indicate that I am fully informed as to the contents of this document and understand the full import of this grant of powers to have the power to consent to the marriage of any of the child/children; (iii) have the power to consent to the adoption of any of the child/children. This power of attorney shall be in effect from __documents. 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)ments 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 ith any health and other insurance for the 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 docunecessary on behalf of the child/children and to adjust, compromise and settle any claim, the child/children may have against any other person or entity. 5. Apply for, purchase, maintain and/or deal w/children, 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 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 childedures. 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 ofsurgical 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 proccessary 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, 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 nes 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, r 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 parentioint ________________________________________ ("Attorney-in-Fact") maintaining an address at: _____________________________________________________ as, my true and lawful agent and attorney-in-fact fo_ Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ I hereby make and appg full legal custody of: Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on _________HESE PRESENTS: I, ___________________________________________________ ("Parent"), maintaining an address at: ________________________________________. I am an adult and I am the custodial parent havincepting or acting under the 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 T attorney document, is legally 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 acorney-in-Fact") with the power 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 ofs granted by this Power of Attorney for the Care of Children document are broad and sweeping. Before signing this document, consider its consequences. You ("Parent") are providing another person ("Atton that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PARENT: The power be witnessed, it is always 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 informatistate does not require it. Notarization 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 Attorneyg and an "end/expiration" date, the Parent 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 ttorney-in-Fact. The Parent should 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 beginninf document. The Parent should be 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 Alems when, for example, arranging 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 odren to the Attorneyin-fact. By 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 probfare decisions. This can be useful if the Parent will be absent for a period of time. The powers granted by this instrument are very broad. The Parent is basically giving temporary custody of the chile can be appointed an Attorney-in-Fact by a power of attorney. This form allows the Attorney-in-Fact to make decisions for the children in place of the Parent, including health care, education and welhildren on a temporary basis. The word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-in-Fact for the Parent or the children does not need to be a lawyer. Almost anyonled the "Principal" or "Grantor") of one or more children, who has full/sole legal custody of the child/children to appoint another person to act as his or her Attorney-in-Fact to care for the child/c 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 be used. This document allows a single parent (sometimes cal of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Power of Attorney for the Care of Children (Single Parent / One Custodial Parent) Wheneverms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting an attorney first. [_] The purchase and useinstructions to the Attorney-in-Fact. The Parent should also be very careful in the selection of the Attorney-in-Fact, as the powers granted by this document are very broad and sweeping. [_] These for of Attorney. The witnesses should be adults. Generally, anyone related by blood or marriage to the Parent, Attorney-in-Fact or Notary should not be a witness. [_] The Parent should be careful giving is or her records. [_] At least one witness should sign the Power of Attorney for the Care of Children. Although not always required, it is always a good idea to also have two witnesses sign the Poweroriginal Power of Attorney for the Care of Children document should be given to the Attorney-in-Fact. [_] The Parent should keep a copy of the Power of Attorney for the Care of Children document for harent with full/sole legal custody) needs to sign the Power of Attorney for the Care of Children. [_] The Power of Attorney for the Care of Children document should be signed before a Notary. [_] The ple instructions plus a checklist; and (3) additional useful information about Power of Attorney for the Care of Children - (Single Parent / One Custodial Parent). [_] The Custodial Parent (i.e. one pInstructions & Checklist Louisiana Power of Attorney for the Care of Children (Single Parent / One Custodial Parent) [_] This package contains a (1) Power of Attorney for the Care of Children; (2) sim Louisiana