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Maine __________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -4- _______________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. ______________________________________ State: ___________________________________ -3- State of MAINE ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of _______________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: ___________________, at _______________________ (city), Maine. ________________________________ Signature of Parent Witness Signature: ___________________________________ Name: ___________________________________ City: h termination, shall be held harmless. I may revoke this Power of Attorney before the expiration date at any time by providing written notice to the Attorney-in-Fact. Signed on ________________ (date)ty 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 authority of this document, without notice of sucower of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third 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 this document may act under it. Revocation of the ps 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 applicable law, then the remaining unaffected parm 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 reimbursement of all reasonable expenses incurred ang 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 the Attorney-in-Fact named herein. I hereby ratify and confirren; (iii) have the power to consent to the adoption of any of the child/children. -2- This power of attorney shall be in effect from _______________ to _______________ ("expiration date"). By signiy, Attorney-in-Fact shall not (i) have the authority to withhold or withdraw life sustaining procedures for any child/children; (ii) have the power to consent to the marriage of any of the child/childcument, including but not limited to consent forms, releases, waivers, insurance documents, claims, agreements, contracts and legal documents. Notwithstanding other provisions in this Power of Attornee and file any medical or other type of claim against any health or other type of insurance company. 6. Endorse and execute any documents necessary for the performance of the powers granted by this doand settle any claim, the child/children may have against any other person or entity. 5. Apply for, purchase, maintain and/or deal with any health and other insurance for the child/children and to mak quarters, food, clothing, entertainment and other customary matters. 4. Request, ask, demand, sue and take any and all legal steps necessary on behalf of the child/children and to adjust, compromise n 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 livingo 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 ill 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 tany 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 sha 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 e 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 otherbove-named minor child/children: -1- 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 thaintaining 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 a________________________________ born on __________ Name: _________________________________ born on __________ I hereby make and appoint ________________________________________ ("Attorney-in-Fact") mn on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: __ ("Parent"), maintaining an address at: ________________________________________. I am an adult and I am the custodial parent having full legal custody of: Name: _________________________________ bor of Children or your duties under it that you do not understand, you should ask a lawyer to explain it to you. KNOW ALL PERSONS BY THESE PRESENTS: I, __________________________________________________ary duty under this Power of Attorney for the Care of Children, you may be liable for damages and may be subject to criminal prosecution. If there is anything about this Power of Attorney for the Caren Maine case law. As the Agent, your authority under this Power of Attorney for the Care of Children will end on the termination date or sooner if revoked by the Principals. If you violate your fiducithey sign it. As the Agent, you are under a duty (called a "fiduciary duty") to observe the standards observed by a prudent person. The duty is explained more fully in the Maine Revised Statutes and ithe Principals' in accordance with the terms of this Power of Attorney for the Care of Children. This Power of Attorney for the Care of Children is valid only if the Principals are of sound mind when it to you. Notice to the Agent: As the "Agent" or "Attorney-in-Fact," you are given power under this Power of Attorney for the Care of Children to make decisions about the health, welfare and care of this Power of Attorney for the Care of Children at any time. If there is anything about this Power of Attorney for the Care of Children that you do not understand, you should ask a lawyer to explain e notice to you or approval by you. Some of the powers that you give your Agent are explained more fully in the Maine Revised Statutes, and in Maine case law. You have the right to revoke or take backur children on your behalf. If this written Power of Attorney for the Care of Children does not limit the powers that you give your Agent, your Agent will have broad and sweeping powers without advanc As the "Principal," you are using this General Power of Attorney to grant power to another person (called the "Agent" or "Attorney-in-Fact") to make decisions about the health, welfare and care of yoing 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 Notice to the Principals:orney 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 accepty-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 of attanted 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 ("Attornehat 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 powers grwitnessed, 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 information te 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 Attorney be d 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 statney-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 beginning ancument. 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 Attor 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 of do 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 problems 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 childrenn 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 welfareren 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 anyone cathe "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/childbecomes 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 called 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) Whenever it re 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 use of ructions 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 forms aAttorney. 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 instr 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 Power of inal 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 his ot 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 originstructions 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 parenInstructions & Checklist Maine 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) simple Maine