I, residing at , as the parent of (the "Child"), born on residing at , hereby appoint (the "Agent") residing at , to act on my behalf in performing responsibilities and executing any of the below-listed specific acts connected with the Child under the following terms and conditions (the "Power of Attorney"):
EFFECTIVE DATE AND DURATION. This Power of Attorney shall be effective from and will remain in effect until or until it is revoked, whichever occurs first.
DELEGATION OF AUTHORITY. I hereby grant all parental powers regarding care and custody of the Child I might perform myself.
LIMITATIONS AND CONDITIONS. This Power of Attorney does not grant the power to consent to the marriage or adoption of the Child and does not mean the termination of the parental rights. This Power of Attorney does not authorize the Agent to consent to any performance or inducement of abortion on or for the Child, nor does it provide any authority to the Agent to terminate or waive any parental rights on behalf of the undersigned parent. .
MANNER OF REVOCATION. This Power of Attorney may be instantly revoked at any time before the expiration date, regardless of whether the Agent has completed specific tasks or achieved specific goals. The Power of Attorney may also be revoked for any reason or if the Agent exceeds or violates the scope and authority granted by this Power of Attorney.
COMPENSATION. For acting on my behalf under this Power of Attorney, the Agent will receive compensation of , which is due to be paid on or before .
IN WITNESS THEREOF, this Power of Attorney is executed on .
Signature: ____________________________
Full legal name:
NOTARY ACKNOWLEDGMENT
State of
Acting in the county of
Sworn to and subscribed before me on ___________________________.
___________________________________
Place for signature
______________________________________
Notary public's name and seal