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Wyoming ___ Name typed, printed, or stamped -3- to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _____________________________________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known ___________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ State of __________________________ ) ) ss County of _e: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: ________________to the Attorney-in-Fact. Signed on ________________ (date), at _______________________ (city), __________________________ (state). ________________________________ Signature of Parent Witness Signaturhe 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 written notice arty 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 t 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 the third per 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 receives a copy of 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 unenforceable undney-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 entitled to___ 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 the Attorpower 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 ____________ 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) have the ssary 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 documents.alth 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 documents neceon 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 with any he 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 necessary /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 child/children, 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 of the childr 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 procedures. 2.sclose 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, surgical oand 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 necessary dio 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, authorize n 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 parentis and to d___________________________________ ("Attorney-in-Fact") maintaining an address at: _____________________________________________________ as, my true and lawful agent and attorney-in-fact for me and i_______________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ I hereby make and appoint _____al custody of: Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: __NTS: I, ___________________________________________________ ("Parent"), maintaining an address at: ________________________________________. I am an adult and I am the custodial parent having full leg 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 THESE PRESEdocument, 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 accepting oract") 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 attorney 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 ("Attorney-in-F 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 granted sed, 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 that is 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 witnesend/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 state does-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 and an ". 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 Attorney-in 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 documente 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 when,ions. 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 children to thppointed 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 welfare decis 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 can be arincipal" 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/children ons 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 the "Pforms, 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 become 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 these ns 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 are notey. 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 instructiorecords. [_] 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 Attornower 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 or her 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 original Pctions 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 parent withInstructions & Checklist 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 instru Wyoming